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Individual

THOMAS JOHN KELLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LADC

Contact information

Practice address
1 DELTA DR, WESTBROOK, ME 04092-4745
(207) 853-7227
(207) 856-2112
Mailing address
10 BROOKSIDE DR, CUMBERLAND, ME 04021-4057
(207) 357-3774

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LC3444
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
207LA0401X
ME
Enumeration date
07/27/2018
Last updated
07/27/2018
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