| Doctor Name: | ALISA RENEE WING |
| NPI Number: | 1841605557 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA/CAS |
| License Number: | 459729 |
| Business Practice Address: | 28a Main Road South Hampden, ME - 04444 |
| Business Phone Number: | 2078622774 |
| Business Fax Number: | |
| Mailing Address: | 14 Rugosa Ln, LEVANT |
| State: | ME |
| Postal Code: | 044564459 |
| Phone Number: | 2076316211 |
| Fax Number: | |
| NPI Enumeration Date: | 06/23/2014 |
| NPI Last Update Date: | 06/23/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | 459729 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |