Healthcare Provider Details

I. General information

NPI: 1891325809
Provider Name (Legal Business Name): NORTHWOODS COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 DOW RD
ORRINGTON ME
04474-3539
US

IV. Provider business mailing address

283 DOW RD
ORRINGTON ME
04474-3539
US

V. Phone/Fax

Practice location:
  • Phone: 207-300-5855
  • Fax:
Mailing address:
  • Phone: 207-300-5855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FRANCIS COLAVECCHIO
Title or Position: CEO
Credential: LCPC
Phone: 207-300-5855