Individual
JONATHAN CROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
49 MONTROSE AVE APT 3, PORTLAND, ME 04103-2442
(207) 400-5122
Mailing address
49 MONTROSE AVE APT 3, PORTLAND, ME 04103-2442
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CAC6296
ME
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LC6907
ME
Other
Enumeration date
06/16/2020
Last updated
06/19/2020
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