Individual
JESSICA L. DISANTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC, CADC
Contact information
Practice address
474 MAIN ST, SPRINGVALE, ME 04083-1409
(207) 324-1500
(207) 490-5263
Mailing address
190 RIVERSIDE ST, SUITE 6B, PORTLAND, ME 04103-1073
(207) 661-2000
(207) 661-2033
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CAC4355
ME
101YP2500X
Professional Counselor
Primary
CC4820
ME
Other
Enumeration date
09/09/2014
Last updated
05/09/2017
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