Individual
SAMANTHA MEDEIROS FREDERICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC
Contact information
Practice address
400 WESTERN AVE, SOUTH PORTLAND, ME 04106-1704
(207) 405-0003
Mailing address
400 WESTERN AVE, SOUTH PORTLAND, ME 04106-1704
(207) 405-0003
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CAC9317
ME
Other
Enumeration date
02/17/2026
Last updated
02/17/2026
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