Provider Demographics
NPI:1699445361
Name:ALLAGASH ADDICTION ASSOCIATES PLLC
Entity type:Organization
Organization Name:ALLAGASH ADDICTION ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALANE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:207-558-6124
Mailing Address - Street 1:254 COMMERCIAL ST STE 245
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4899
Mailing Address - Country:US
Mailing Address - Phone:207-558-6124
Mailing Address - Fax:
Practice Address - Street 1:254 COMMERCIAL ST STE 245
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4899
Practice Address - Country:US
Practice Address - Phone:207-558-6124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty