Provider Demographics
NPI:1457782187
Name:STALLING, KAITLIN ROSE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:KAITLIN
Middle Name:ROSE
Last Name:STALLING
Suffix:
Gender:F
Credentials:LCPC
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Mailing Address - Street 1:C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT
Mailing Address - Street 2:PO BOX 7291
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-7291
Mailing Address - Country:US
Mailing Address - Phone:207-777-8950
Mailing Address - Fax:207-777-8800
Practice Address - Street 1:100 CAMPUS AVE STE A&B
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6040
Practice Address - Country:US
Practice Address - Phone:207-755-3434
Practice Address - Fax:207-755-3474
Is Sole Proprietor?:No
Enumeration Date:2013-12-05
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4268101YP2500X
MECC4708101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional