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General NPI Number Information
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NPI Number | 1760152276
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Entity Type | Organization
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Legal Business Name | CENTER FOR COLLABORATIVE FAMILY THERAPY, PLLC
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Dates
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Enumeration Date | 09/16/2021
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Last Update Date | 09/16/2021
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Provider Practice Location Address
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Address Line | 21 MEMORIAL HWY
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City | NORTH YARMOUTH
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State | ME
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Zip | 04097-6327
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Country | US
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Telephone | 207-489-9393
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Fax | 207-489-9393
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Provider Business Mailing Address
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Address Line | 119 RAVINE DR
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City | CUMBERLAND FORESIDE
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State | ME
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Zip | 04110-1134
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Country | US
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Telephone | 585-354-7724
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Fax | 207-489-9393
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. JENNIFER KING
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Credential | PHD, LMFT
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Telephone | 207-489-9393
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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 | 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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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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