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Individual

JENNIFER SMALL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LADC, CCS

Contact information

Practice address
235 MAIN ST, NORWAY, ME 04268-5943
(207) 739-2644
Mailing address
235 MAIN ST, NORWAY, ME 04268-5943
(207) 739-2644
(207) 739-2467

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LC2466
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
417940099
ME
Enumeration date
06/06/2006
Last updated
10/28/2019
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