Provider Demographics
NPI:1003191230
Name:MELLOWS, RAMONA L (LADC)
Entity Type:Individual
Prefix:MS
First Name:RAMONA
Middle Name:L
Last Name:MELLOWS
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 AUSTIN DR
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04473-3686
Mailing Address - Country:US
Mailing Address - Phone:207-649-7490
Mailing Address - Fax:
Practice Address - Street 1:26 FOREST AVE
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04473-3647
Practice Address - Country:US
Practice Address - Phone:207-649-7490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4652101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)