Provider Demographics
NPI:1083313902
Name:THE CANVAS OF LIFE COUNSELING LLC
Entity Type:Organization
Organization Name:THE CANVAS OF LIFE COUNSELING LLC
Other - Org Name:THE CANVAS OF LIFE COUNSELING LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER, PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MANSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, CADC, CGP
Authorized Official - Phone:207-241-9332
Mailing Address - Street 1:140 CANAL ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7777
Mailing Address - Country:US
Mailing Address - Phone:207-241-9332
Mailing Address - Fax:207-782-9011
Practice Address - Street 1:140 CANAL ST STE 2
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7777
Practice Address - Country:US
Practice Address - Phone:207-241-9332
Practice Address - Fax:207-782-9011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-28
Last Update Date:2023-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty