Provider Demographics
NPI:1558775197
Name:NEW LIFE COUNSELING, LLC
Entity Type:Organization
Organization Name:NEW LIFE COUNSELING, LLC
Other - Org Name:NEW LIFE COUNSELING, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCHETTE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:207-749-2343
Mailing Address - Street 1:1321 WASHINGTON AVE
Mailing Address - Street 2:SUITE304
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3636
Mailing Address - Country:US
Mailing Address - Phone:207-749-2343
Mailing Address - Fax:
Practice Address - Street 1:251 WOODFORD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-5617
Practice Address - Country:US
Practice Address - Phone:207-749-2343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1372103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty