Healthcare Provider Details

I. General information

NPI: 1952859035
Provider Name (Legal Business Name): CARLY RICE L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 SAINT JOHN ST STE 127
PORTLAND ME
04102-3055
US

IV. Provider business mailing address

222 SAINT JOHN ST STE 127
PORTLAND ME
04102-3055
US

V. Phone/Fax

Practice location:
  • Phone: 802-302-9300
  • Fax:
Mailing address:
  • Phone: 802-302-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC847
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number21888
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: