Provider Demographics
NPI:1659723088
Name:YOUR JOURNEY, LLC
Entity Type:Organization
Organization Name:YOUR JOURNEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-493-5210
Mailing Address - Street 1:92 BENNETT DR STE 1
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-1952
Mailing Address - Country:US
Mailing Address - Phone:207-493-5210
Mailing Address - Fax:207-493-5209
Practice Address - Street 1:92 BENNETT DR STE 1
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-1952
Practice Address - Country:US
Practice Address - Phone:207-493-5210
Practice Address - Fax:207-493-5209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC5672251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME=========OtherNPI TYPE I: 1245345065