Provider Demographics
NPI:1336554021
Name:MAINE HOLISTIC COUNSELING LLC
Entity Type:Organization
Organization Name:MAINE HOLISTIC COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALEANA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KRUPINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-620-4691
Mailing Address - Street 1:62 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:ME
Mailing Address - Zip Code:04344-2800
Mailing Address - Country:US
Mailing Address - Phone:207-620-4691
Mailing Address - Fax:207-588-7363
Practice Address - Street 1:62 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:ME
Practice Address - Zip Code:04344-2800
Practice Address - Country:US
Practice Address - Phone:207-620-4691
Practice Address - Fax:207-588-7363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-22
Last Update Date:2014-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC133941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty