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General NPI Number Information
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NPI Number | 1225006380
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Entity Type | Organization
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Legal Business Name | THE RIVERSIDE COMMUNITY CENTER, INC
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 04/04/2011
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Provider Practice Location Address
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Address Line | 43 FLEMING ST
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City | LINCOLN
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State | ME
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Zip | 04457-1451
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Country | US
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Telephone | 207-794-6280
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Fax |
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Provider Business Mailing Address
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Address Line | 43 FLEMING ST
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City | LINCOLN
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State | ME
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Zip | 04457-1451
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Country | US
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Telephone | 207-794-2150
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Fax | 207-794-6280
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. DONNA G. COWAN
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Credential | M.ED./CADC
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Telephone | 207-794-2150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 266141
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License Number State | ME
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