Organization
ROSALIE GENOVA, LCPC, CCS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSALIE GENOVA LCPC, CCS (OWNER)
(207) 200-3789
Entity
Organization
Contact information
Practice address
1250 FOREST AVE, PORTLAND WELLNESS COOPERATIVE, UNIT 14, SUITE 7, PORTLAND, ME 04103
(207) 200-3789
Mailing address
1250 FOREST AVE, PORTLAND WELLNESS COOPERATIVE, UNIT 14, SUITE 7, PORTLAND, ME 04103
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
11/08/2022
Last updated
11/08/2022
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