Basic Information
| Provider Information | |||||||||
| NPI: | 1053680744 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY HEALTH AND COUNSELING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 42 CEDAR ST | ||||||||
| Address2: | P.O.BOX 425 | ||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044016433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079470366 | ||||||||
| FaxNumber: | 2079424350 | ||||||||
| Practice Location | |||||||||
| Address1: | 42 CEDAR ST | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044016433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079470366 | ||||||||
| FaxNumber: | 2079424350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/24/2011 | ||||||||
| LastUpdateDate: | 12/24/2011 | ||||||||
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| AuthorizedOfficialLastName: | MONAHAN | ||||||||
| AuthorizedOfficialFirstName: | KATHERINE | ||||||||
| AuthorizedOfficialMiddleName: | LOUISE | ||||||||
| AuthorizedOfficialTitleorPosition: | THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 2079470366 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCPC-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | XL3735 | ME | Y | Agencies | Community/Behavioral Health |
No ID Information.