Individual
WYATT T COULON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3175
(207) 662-1888
Mailing address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(207) 662-0111
(207) 662-6006
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC19827
ME
Other
Enumeration date
04/08/2022
Last updated
04/01/2025
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