| Hidden Glade Counseling, LLC | |
|
1 Union St Ste 501 Portland ME 04101-4050 | |
| (508) 499-9694 | |
| Not Available |
| Full Name | Hidden Glade Counseling, LLC |
|---|---|
| Speciality | Social Worker |
| Location | 1 Union St Ste 501, Portland, Maine |
| Authorized Official Name and Position | Christopher Alan Holloway (OWNER) |
| Authorized Official Contact | 5084999694 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hidden Glade Counseling, LLC Po Box 307 Brunswick ME 04011-0307 | Hidden Glade Counseling, LLC 1 Union St Ste 501 Portland ME 04101-4050 Ph: (508) 499-9694 |
| NPI Number | 1245024975 |
|---|---|
| Provider Enumeration Date | 04/07/2025 |
| Last Update Date | 04/07/2025 |
| Certification Date | 04/07/2025 |
| Medicare PECOS PAC ID | 8921500802 |
|---|---|
| Medicare Enrollment ID | O20250909001128 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245024975 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | () | Secondary |
| 101YM0800X | Counselor - Mental Health | () | Secondary |
| 104100000X | Social Worker | () | Secondary |
| 1041C0700X | Social Worker - Clinical | () | Primary |
| Provider Name | Christopher Alan Holloway |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033819776 PECOS PAC ID: 1557801123 Enrollment ID: I20240910001693 |
| Provider Name | Brittany L Fenderson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124755616 PECOS PAC ID: 2163940628 Enrollment ID: I20250519001111 |
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