Healthcare Provider Details

I. General information

NPI: 1609837327
Provider Name (Legal Business Name): DULCIE Y WITMAN LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 SAINT JOHN ST STE 102
PORTLAND ME
04102
US

IV. Provider business mailing address

222 SAINT JOHN ST STE 102
PORTLAND ME
04102
US

V. Phone/Fax

Practice location:
  • Phone: 207-775-4026
  • Fax: 207-775-4026
Mailing address:
  • Phone: 207-775-4026
  • Fax: 207-775-4026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLC1467
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: