Healthcare Provider Details

I. General information

NPI: 1699630384
Provider Name (Legal Business Name): MAINE FAMILY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 AUBURN ST
PORTLAND ME
04103-2141
US

IV. Provider business mailing address

94 AUBURN ST
PORTLAND ME
04103-2141
US

V. Phone/Fax

Practice location:
  • Phone: 207-613-4473
  • Fax:
Mailing address:
  • Phone: 207-613-4473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CAMILLE THAYER
Title or Position: OWNER/COUNSELOR
Credential: LCPC-C, M.S.
Phone: 207-213-0679