Individual
MRS. JANE TULL WATSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW-CC, CADC
Contact information
Practice address
477 CONGRESS ST, SUITE 408, PORTLAND, ME 04101-3427
(207) 773-7811
(207) 773-0663
Mailing address
899 RIVERSIDE ST, PORTLAND, ME 04103-1070
(207) 871-1211
(207) 871-1232
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CAC5226
ME
1041C0700X
Clinical Social Worker
Primary
MC13689
ME
Other
Enumeration date
09/06/2012
Last updated
09/06/2012
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