Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | CC5830 | ME |
NPI | 1003458613 |
---|---|
Provider Name | Beth Cottrell |
First Address | Old Town, ME 04468-5925 |
Second Address | Bangor, ME 04401-3005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2019 |
Last Update Date | 30/04/2021 |