Individual
WILLIAM BLAINE-WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
456 NEW VINEYARD RD, FARMINGTON, ME 04938-5216
(207) 491-9645
Mailing address
456 NEW VINEYARD RD, FARMINGTON, ME 04938-5216
(207) 491-9645
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
XP4415
ME
Other
Enumeration date
04/05/2017
Last updated
04/05/2017
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