Doctor Name: | JESSIE DALEY |
NPI Number: | 1114269909 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A. LPCCC |
License Number: | XL4076 |
Business Practice Address: | 14 Park St Sullivan, ME - 04664 |
Business Phone Number: | 2072660410 |
Business Fax Number: | |
Mailing Address: | 14 Park St, SULLIVAN |
State: | ME |
Postal Code: | 04664 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 03/20/2013 |
NPI Last Update Date: | 03/20/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | XL4076 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |