Individual
MIRANDA NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
165 LANCASTER ST, PORTLAND, ME 04101-2406
(207) 874-1030
Mailing address
165 LANCASTER ST, PORTLAND, ME 04101-2406
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
CC5829
ME
Other
Enumeration date
11/15/2019
Last updated
07/07/2021
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