Doctor Name: | MS. GEORGIA GALE ROSE |
NPI Number: | 1487859773 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LADC |
License Number: | |
Business Practice Address: | 4 Central Ave Limerick, ME - 040480091 |
Business Phone Number: | 2077934933 |
Business Fax Number: | 2077934909 |
Mailing Address: | 279 Mitchell Rd, CAPE ELIZABETH |
State: | ME |
Postal Code: | 04107 |
Phone Number: | 2078991285 |
Fax Number: | |
NPI Enumeration Date: | 06/18/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |