Organization
NEXT STEP DOMESTIC VIOLENCE PROJECT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DORATHY MARTELL (EXECUTIVE DIRECTOR)
(207) 667-0176
Entity
Organization
Contact information
Practice address
733 BANGOR RD, ELLSWORTH, ME 04605-3580
(207) 667-0176
(207) 667-8033
Mailing address
PO BOX 1466, ELLSWORTH, ME 04605-1466
(207) 667-0176
(207) 667-8033
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
XL-4560
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XL-4560
LCPC-C LICENSE NUMBER
ME
Enumeration date
08/01/2017
Last updated
08/01/2017
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