Individual
THERESA C ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
37 MELODY LN, PORTLAND, ME 04103-2814
(617) 947-5889
Mailing address
37 MELODY LN, PORTLAND, ME 04103-2814
(207) 482-3850
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
CC3177
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
432426099
—
ME
Enumeration date
02/01/2007
Last updated
09/04/2014
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