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General NPI Number Information
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NPI Number | 1356132138
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Entity Type | Organization
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Legal Business Name | ENLIGHTENED TIDES, LLC
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 09/11/2025
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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 | 207-212-1946
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Fax |
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Provider Business Mailing Address
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Address Line | 53 SPRINGER FARM RD
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City | SABATTUS
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State | ME
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Zip | 04280-4747
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Country | US
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Telephone | 207-212-1946
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRISTY GELINAS
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Credential | LCSW, LADC, CCS
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Telephone | 207-212-1946
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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 |
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License Number State |
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