Healthcare Provider Details

I. General information

NPI: 1952360760
Provider Name (Legal Business Name): TRANSITIONS COUNSELING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

583 FOREST AVE
PORTLAND ME
04101-1547
US

IV. Provider business mailing address

583 FOREST AVE
PORTLAND ME
04101-1547
US

V. Phone/Fax

Practice location:
  • Phone: 207-773-8886
  • Fax: 207-773-8887
Mailing address:
  • Phone: 207-773-8886
  • Fax: 207-773-8887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number246645
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number411170
License Number StateME

VIII. Authorized Official

Name: KELLI STAR FOX
Title or Position: CEO/PRESIDENT
Credential: LCSW, LADC, CCS
Phone: 207-773-8886