Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | LC4155 | ME |
Y | 1041C0700X | Clinical Social Worker | LC14502 | ME |
NPI | 1003143900 |
---|---|
Provider Name | Terah R. Ames |
First Address | South Portland, ME 04106-5462 |
Second Address | South Portland, ME 04106-5462 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2009 |
Last Update Date | 24/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
432875799 | (05) | ME |