Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | CC2160 | ME |
NPI | 1003101841 |
---|---|
Provider Name | Wanda Sprague |
First Address | Auburn, ME 04210-5983 |
Second Address | Auburn, ME 04210-5983 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2011 |
Last Update Date | 09/06/2011 |