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General NPI Number Information
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NPI Number | 1356992499
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Entity Type | Individual
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Provider Name | AMANDA MARIE PLACE LADC
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Gender | Female
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Dates
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Enumeration Date | 09/20/2019
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Last Update Date | 11/23/2021
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Provider Practice Location Address
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Address Line | 499 STEVENS AVE
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City | PORTLAND
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State | ME
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Zip | 04103-2678
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Country | US
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Telephone | 207-756-4232
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Fax |
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Provider Business Mailing Address
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Address Line | 541 BRIGHTON AVE # A
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City | PORTLAND
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State | ME
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Zip | 04102-2349
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Country | US
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Telephone | 207-756-4232
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | CAC6519
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License Number State | ME
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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 | LC7416
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License Number State | ME
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