Individual
TAMMY MIRANDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC-C, CBIS
Contact information
Practice address
1486B BROADWAY, SOUTH PORTLAND, ME 04106-2602
(207) 602-8660
Mailing address
33 SCHOOL ST, OLD ORCHARD BEACH, ME 04064-2234
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
XL4898
ME
Other
Enumeration date
02/20/2018
Last updated
04/25/2018
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