Healthcare Provider Details

I. General information

NPI: 1891497368
Provider Name (Legal Business Name): MANDALA COUNSELING AND CREATIVE ARTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 MAIN ST
ORONO ME
04473-3439
US

IV. Provider business mailing address

14 FERNWOOD ST
ORONO ME
04473-3817
US

V. Phone/Fax

Practice location:
  • Phone: 207-881-3134
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DARYNE M ROCKETT
Title or Position: OWNER/LCSW
Credential:
Phone: 207-881-3134