Individual
MS. KELLEY ELIZABETH MACKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LADC
Contact information
Practice address
650 MAIN ST, SUITE 103, SOUTH PORTLAND, ME 04106-5448
(207) 774-4564
(207) 774-0006
Mailing address
650 MAIN ST, SUITE 103, SOUTH PORTLAND, ME 04106-5448
(207) 774-4564
(207) 774-0006
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LC3942
ME
Other
Enumeration date
02/13/2011
Last updated
02/13/2011
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