Individual
KASSANDRA M SHACKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
587 OCEAN AVE, PORTLAND, ME 04103-2701
(207) 871-1582
(207) 871-9276
Mailing address
901 WASHINGTON AVE STE 100, PORTLAND, ME 04103-2842
(207) 871-1200
(207) 871-1232
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
08/29/2019
Last updated
08/29/2019
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