Healthcare Provider Details

I. General information

NPI: 1942259049
Provider Name (Legal Business Name): COMMON GROUND COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 MAIN ST
NORWAY ME
04268-5943
US

IV. Provider business mailing address

PO BOX 1328
AUBURN ME
04211-1328
US

V. Phone/Fax

Practice location:
  • Phone: 207-739-2644
  • Fax: 207-739-2467
Mailing address:
  • Phone: 207-784-9185
  • Fax: 207-784-1594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateME

VIII. Authorized Official

Name: JENNIFER RAUDONIS
Title or Position: OWNER
Credential: LADC
Phone: 207-739-2644