Individual
KELLI STAR FOX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW LADC CCS
Contact information
Practice address
4 DEMEREST ST, PORTLAND, ME 04103-4329
(207) 831-0304
Mailing address
4 DEMEREST ST, PORTLAND, ME 04103-4329
(207) 831-0304
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LC689
ME
1041C0700X
Clinical Social Worker
Primary
LC4378
ME
Other
Enumeration date
05/02/2006
Last updated
06/25/2020
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