Individual
SHASTA MINERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1048 SOUTH ST, DOVER FOXCROFT, ME 04426-1232
(207) 564-3000
(207) 422-7339
Mailing address
PO BOX 405, TENANTS HARBOR, ME 04860-0405
(207) 975-3929
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LC22698
ME
Other
Enumeration date
10/17/2024
Last updated
07/14/2025
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