Provider Demographics
NPI:1174807374
Name:CIALFI, JUSTIN CLARK (LCPC-C)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:CLARK
Last Name:CIALFI
Suffix:
Gender:M
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SOUTH EVERGREEN LANE
Mailing Address - Street 2:
Mailing Address - City:ARUNDEL
Mailing Address - State:ME
Mailing Address - Zip Code:04046
Mailing Address - Country:US
Mailing Address - Phone:207-590-5384
Mailing Address - Fax:
Practice Address - Street 1:6D WELLSPRING ROAD
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005
Practice Address - Country:US
Practice Address - Phone:207-590-5384
Practice Address - Fax:207-282-7316
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3795101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional