Individual
SHELLEY ALANE THERIAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
15 KIDS COR, MACHIAS, ME 04654-3328
(207) 255-8473
Mailing address
530 ROUTE 1, PEMBROKE, ME 04666-4425
(207) 214-0255
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
MC13939
ME
Other
Enumeration date
12/14/2012
Last updated
12/14/2012
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