Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | LP584 | ME |
N | 101YP2500X | Professional Counselor | CC583 | ME |
NPI | 1164533766 |
---|---|
Provider Name | Charles Waite Maclin |
First Address | Portland, ME 04104 |
Second Address | Portland, ME 04104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CC583 | STATE OF MAINE (01) | ME |
LP584 | STATE OF MAINE (01) | ME |