Provider Demographics
NPI:1487749222
Name:WOODIN, NATHAN ALEC (LMFT, RPT)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:ALEC
Last Name:WOODIN
Suffix:
Gender:M
Credentials:LMFT, RPT
Other - Prefix:MR
Other - First Name:NATE
Other - Middle Name:ALEC
Other - Last Name:WOODIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT, RPT
Mailing Address - Street 1:142 HIGH ST
Mailing Address - Street 2:SUITE 601-D
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2851
Mailing Address - Country:US
Mailing Address - Phone:207-956-1156
Mailing Address - Fax:
Practice Address - Street 1:142 HIGH ST
Practice Address - Street 2:SUITE 601-D
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2851
Practice Address - Country:US
Practice Address - Phone:207-956-1156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMF3712106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist