Provider Demographics
NPI:1962902775
Name:ROY, WENDY L (CADC, MHRT-C)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:L
Last Name:ROY
Suffix:
Gender:F
Credentials:CADC, MHRT-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 RICHARD ST
Mailing Address - Street 2:
Mailing Address - City:GREENE
Mailing Address - State:ME
Mailing Address - Zip Code:04236-3406
Mailing Address - Country:US
Mailing Address - Phone:207-402-4437
Mailing Address - Fax:
Practice Address - Street 1:24 DUNN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6821
Practice Address - Country:US
Practice Address - Phone:207-784-2901
Practice Address - Fax:207-514-7005
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC6299101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)