Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CAC4852 | ME |
N | 101YP2500X | Professional Counselor | XL3593 | ME |
NPI | 1003117573 |
---|---|
Provider Name | Cynthia Sue Reid |
First Address | Bangor, ME 04401-4324 |
Second Address | Bangor, ME 04401-4324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2010 |
Last Update Date | 31/05/2012 |