Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | LC7318 | ME |
NPI | 1003011487 |
---|---|
Provider Name | Ms. Jean Marie Wakem |
First Address | Searsmont, ME 04973-3323 |
Second Address | Belfast, ME 04915-6006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2007 |
Last Update Date | 08/07/2007 |