Provider Demographics
NPI:1952779407
Name:HUOTARI, GABRIELLE AARON (CADC)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:AARON
Last Name:HUOTARI
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 MAIN ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-5448
Mailing Address - Country:US
Mailing Address - Phone:207-430-3777
Mailing Address - Fax:
Practice Address - Street 1:650 MAIN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-5448
Practice Address - Country:US
Practice Address - Phone:207-430-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC5909101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)