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General NPI Number Information
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NPI Number | 1982842274
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Entity Type | Organization
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Legal Business Name | GATEWAYS, PA
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Dates
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Enumeration Date | 01/26/2009
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Last Update Date | 08/12/2009
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Provider Practice Location Address
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Address Line | 4 MARKET SQ SUITE 1
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City | HOULTON
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State | ME
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Zip | 04730-1735
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Country | US
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Telephone | 207-532-3222
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Fax | 207-532-3288
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Provider Business Mailing Address
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Address Line | 4 MARKET SQ SUITE 1
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City | HOULTON
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State | ME
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Zip | 04730-1735
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Country | US
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Telephone | 207-532-3222
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Fax | 207-532-3288
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MS. LINDA R MCCORD
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Credential | LCSW, LADC
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Telephone | 207-532-3222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 582260
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License Number State | ME
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