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General NPI Number Information
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NPI Number | 1861704488
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Entity Type | Individual
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Provider Name | CHRISTINA FAY LCSW, LADC, CCS
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Gender | Female
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Dates
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Enumeration Date | 07/12/2010
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Last Update Date | 11/14/2023
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Provider Practice Location Address
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Address Line | 68 BISHOP ST STE 3
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City | PORTLAND
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State | ME
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Zip | 04103-2681
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Country | US
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Telephone | 207-281-2681
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Fax |
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Provider Business Mailing Address
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Address Line | 140 SAND BAR RD
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City | WINDHAM
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State | ME
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Zip | 04062-5540
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Country | US
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Telephone | 207-281-2681
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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 | LC4524
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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 | CCS4684
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC11294
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License Number State | ME
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