Organization
BREATHING SPACE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNE W POLAK LCPC (OWNER)
(207) 212-9512
Entity
Organization
Contact information
Practice address
132 MAIN ST, SUITE 205, BRIDGTON, ME 04009-1127
(207) 212-9512
Mailing address
PO BOX 445, BRIDGTON, ME 04009-0445
(207) 212-9512
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
CC3042
ME
Other
Enumeration date
09/27/2011
Last updated
09/27/2011
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