Organization
MINT CONDITION COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE E BLAKE LCSW, LADC (SOLE MEMBER/OWNER)
(603) 860-4900
Entity
Organization
Contact information
Practice address
40 BRACKETT ST APT 3, WESTBROOK, ME 04092-3383
(603) 860-4900
Mailing address
40 BRACKETT ST APT 3, WESTBROOK, ME 04092-3383
(603) 860-4900
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2077079813
INDIV NPI
—
Enumeration date
03/03/2022
Last updated
12/22/2022
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