Healthcare Provider Details

I. General information

NPI: 1669394391
Provider Name (Legal Business Name): NORTHEAST COUNSELING & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 ROOSEVELT TRL STE 3A
WINDHAM ME
04062-5286
US

IV. Provider business mailing address

733 ROOSEVELT TRL STE 3A
WINDHAM ME
04062-5286
US

V. Phone/Fax

Practice location:
  • Phone: 207-239-8400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CRAIG FREY
Title or Position: OWNER
Credential:
Phone: 207-239-8400