Individual
SUSAN WILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
125 PRESUMPSCOT ST, PORTLAND, ME 04103-5225
(207) 871-1000
Mailing address
1080 BROADWAY APT 4, SOUTH PORTLAND, ME 04106-5720
(207) 899-2761
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
XL4841
ME
Other
Enumeration date
02/21/2017
Last updated
02/21/2017
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