Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | LC4652 | ME |
NPI | 1003191230 |
---|---|
Provider Name | Ms. Ramona L Mellows |
First Address | Orono, ME 04473-3686 |
Second Address | Orono, ME 04473-3647 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2011 |
Last Update Date | 19/10/2011 |