Healthcare Provider Details

I. General information

NPI: 1033045844
Provider Name (Legal Business Name): SHELBY KLIMAS LADC, CCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 PORTLAND AVE
OLD ORCHARD BEACH ME
04064-2212
US

IV. Provider business mailing address

56 PARADISE LN
NORTH WATERBORO ME
04061-4792
US

V. Phone/Fax

Practice location:
  • Phone: 207-272-5371
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCCS9438
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLC9306
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: