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General NPI Number Information
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NPI Number | 1972245728
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Entity Type | Organization
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Legal Business Name | THE INTEGRATED LIFE
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Dates
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Enumeration Date | 04/12/2022
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 28 STATE ST STE 5
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City | GORHAM
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State | ME
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Zip | 04038-1147
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Country | US
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Telephone | 207-894-4278
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Fax |
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Provider Business Mailing Address
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Address Line | 28 STATE ST STE 5
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City | GORHAM
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State | ME
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Zip | 04038-1147
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Country | US
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Telephone | 207-894-4278
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Fax |
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Authorized Official
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Title or Position | FOUNDER/CLINICAL DIRECTOR
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Name | JAMIE RACINE
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Credential | LCSW
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Telephone | 207-894-4278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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