Healthcare Provider Details

I. General information

NPI: 1851177968
Provider Name (Legal Business Name): KYLA ANNE GLADSTONE LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 US ROUTE 1 STE A
YORK ME
03909-1638
US

IV. Provider business mailing address

439 US ROUTE 1 STE A
YORK ME
03909-1638
US

V. Phone/Fax

Practice location:
  • Phone: 207-367-9444
  • Fax:
Mailing address:
  • Phone: 207-367-9444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC8538
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: