Healthcare Provider Details

I. General information

NPI: 1952779407
Provider Name (Legal Business Name): GABRIELLE AARON HUOTARI CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 MAIN ST SUITE 105
SOUTH PORTLAND ME
04106-5448
US

IV. Provider business mailing address

650 MAIN ST SUITE 105
SOUTH PORTLAND ME
04106-5448
US

V. Phone/Fax

Practice location:
  • Phone: 207-430-3777
  • Fax:
Mailing address:
  • Phone: 207-430-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAC5909
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: