Individual
JACK CHELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC
Contact information
Practice address
28 PORTLAND AVE, OLD ORCHARD BEACH, ME 04064-2212
(207) 934-5231
(207) 934-5139
Mailing address
28 PORTLAND AVE, OLD ORCHARD BEACH, ME 04064-2212
(207) 934-5231
(207) 934-5139
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CAC5765
ME
Other
Enumeration date
01/29/2015
Last updated
01/29/2015
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