Individual
GRACE PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
104 BRACKETT ST, PORTLAND, ME 04102-3824
(480) 631-9834
Mailing address
104 BRACKETT ST, PORTLAND, ME 04102-3824
(207) 871-1200
(207) 871-1232
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
CC7280
ME
Other
Enumeration date
12/30/2021
Last updated
11/04/2025
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