Individual
NICHOLE LAVALLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1461 MOOSEHEAD TRL, JACKSON, ME 04921
(207) 907-2631
Mailing address
119 LOWER DETROIT RD, PLYMOUTH, ME 04969-3213
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
ALLS 2297
ME
Other
Enumeration date
02/07/2007
Last updated
10/30/2019
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