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General NPI Number Information
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NPI Number | 1346543634
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Entity Type | Organization
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Legal Business Name | SOTERIA MENTAL HEALTH
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Dates
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Enumeration Date | 12/08/2010
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Last Update Date | 12/08/2010
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Provider Practice Location Address
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Address Line | 444 STILLWATER AVE SUITE 210
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City | BANGOR
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State | ME
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Zip | 04401-3521
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Country | US
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Telephone | 207-907-4311
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Fax | 207-907-4322
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Provider Business Mailing Address
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Address Line | 444 STILLWATER AVE SUITE 210
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City | BANGOR
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State | ME
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Zip | 04401-3521
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Country | US
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Telephone | 207-907-4311
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Fax | 207-907-4322
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MICHELLE D HENNEBERRY
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Credential | PMHNP
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Telephone | 207-907-4311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State | ME
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