Organization
WHITE CRESCENT WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIA HAGEN LCSW (OWNER/PROVIDER)
(508) 314-3084
Entity
Organization
Contact information
Practice address
222 SAINT JOHN ST STE 314, PORTLAND, ME 04102-3059
(508) 314-3084
Mailing address
222 SAINT JOHN ST STE 314, PORTLAND, ME 04102-3059
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
01/24/2018
Last updated
01/24/2018
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