Individual
PHOENIX R JETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
18 MOLLISON WAY, LEWISTON, ME 04240-5811
(207) 312-6860
Mailing address
18 MOLLISON WAY, LEWISTON, ME 04240-5811
(207) 312-6860
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CAC7863
ME
Other
Enumeration date
05/03/2022
Last updated
08/07/2024
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