Healthcare Provider Details

I. General information

NPI: 1073709713
Provider Name (Legal Business Name): CHRISTIE L HESSELTINE LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 AIRPORT RD
WATERVILLE ME
04901-4524
US

IV. Provider business mailing address

118 MOOSEHEAD TRL STE 5
NEWPORT ME
04953-4056
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-7272
  • Fax:
Mailing address:
  • Phone: 207-368-5189
  • Fax: 207-368-4213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLC5991
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: