Organization
OPEN GATE LLC
Active
Other names
Terra Soma Soul
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA WALLNER LCPC (OWNER)
(207) 710-6505
Entity
Organization
Contact information
Practice address
221 NORTH ST, SACO, ME 04072-1843
(207) 590-4310
Mailing address
PO BOX 12, SACO, ME 04072-0012
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
11/29/2023
Last updated
11/29/2023
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