Provider Demographics
NPI:1265084503
Name:WING, ARLENE MARIE
Entity type:Individual
Prefix:
First Name:ARLENE
Middle Name:MARIE
Last Name:WING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 N CLARY RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:ME
Mailing Address - Zip Code:04348-4062
Mailing Address - Country:US
Mailing Address - Phone:207-549-4282
Mailing Address - Fax:
Practice Address - Street 1:169 SOUTH RD
Practice Address - Street 2:
Practice Address - City:READFIELD
Practice Address - State:ME
Practice Address - Zip Code:04355-3340
Practice Address - Country:US
Practice Address - Phone:207-530-1537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME60251101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME2173383600010OtherLLC NUMBER STATE OF MAINE
ME217338600010OtherLIMITED LIABILITY CORPORATION NUMBER