Healthcare Provider Details

I. General information

NPI: 1114209137
Provider Name (Legal Business Name): DARLEEN SWIFT-POTTER LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 RAILROAD SQ
WATERVILLE ME
04901-6133
US

IV. Provider business mailing address

10 RAILROAD SQ
WATERVILLE ME
04901-6133
US

V. Phone/Fax

Practice location:
  • Phone: 800-434-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLC3491
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: