Basic Information
| Provider Information | |||||||||
| NPI: | 1437559473 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BULL | ||||||||
| FirstName: | ANGELA | ||||||||
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| Credential: | LCPC-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 81 PARKER ST | ||||||||
| Address2: | APT 1 | ||||||||
| City: | BREWER | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044121975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079412952 | ||||||||
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| Practice Location | |||||||||
| Address1: | 700 MOUNT HOPE AVE | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044015691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079412952 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2014 | ||||||||
| LastUpdateDate: | 08/27/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | XL4341 | ME | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.