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General NPI Number Information
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NPI Number | 1083313902
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Entity Type | Organization
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Legal Business Name | THE CANVAS OF LIFE COUNSELING LLC
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Dates
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Enumeration Date | 02/28/2023
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 179 LISBON ST STE 201
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City | LEWISTON
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State | ME
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Zip | 04240-7248
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Country | US
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Telephone | 207-241-9332
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Fax | 207-782-9011
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Provider Business Mailing Address
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Address Line | 179 LISBON ST STE 201
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City | LEWISTON
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State | ME
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Zip | 04240-7248
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Country | US
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Telephone | 207-241-9332
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Fax | 207-782-9011
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Authorized Official
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Title or Position | OWNER, PSYCHOTHERAPIST
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Name | MS. TIFFANY R MANSON
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Credential | LCPC, CADC, CGP
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Telephone | 207-241-9332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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