Individual
NICOLE WETHERELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC, LADC, CCS
Contact information
Practice address
57 EXCHANGE ST STE 402, PORTLAND, ME 04101-5050
(207) 200-7013
Mailing address
525 MAIN ST, SOUTH PORTLAND, ME 04106-5462
(207) 767-0991
(207) 767-0995
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164484093
—
ME
Enumeration date
10/01/2012
Last updated
12/13/2018
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