Individual
MR. WILLIAM RAYMOND WITHAM SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
198 SHEPHERD RD, SIDNEY, ME 04330-2332
(207) 547-3425
(207) 547-3129
Mailing address
198 SHEPHERD RD, SIDNEY, ME 04330-2332
(207) 547-3425
(207) 547-3129
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
ALLS 3033
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128430000
—
ME
Enumeration date
02/12/2009
Last updated
07/24/2009
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