Individual
JASON ROSS ANTKIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
369 MAIN ST, LEWISTON, ME 04240-7030
(207) 782-3386
Mailing address
369 MAIN ST, LEWISTON, ME 04240-7030
(207) 782-3386
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LC5263
ME
Other
Enumeration date
01/08/2013
Last updated
01/08/2013
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