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General NPI Number Information
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NPI Number | 1841605557
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Entity Type | Individual
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Provider Name | ALISA RENEE WING MA/CAS
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Gender | Female
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Dates
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Enumeration Date | 06/23/2014
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Last Update Date | 06/23/2014
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Provider Practice Location Address
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Address Line | 28A MAIN ROAD SOUTH
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City | HAMPDEN
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State | ME
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Zip | 04444
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Country | US
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Telephone | 207-862-2774
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Fax |
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Provider Business Mailing Address
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Address Line | 14 RUGOSA LN
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City | LEVANT
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State | ME
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Zip | 04456-4459
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Country | US
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Telephone | 207-631-6211
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 459729
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License Number State | ME
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