Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 101YP2500X | Professional Counselor | ME |
NPI | 1003393042 |
---|---|
Provider Name | Emily A Goode |
First Address | Bangor, ME 04402-1599 |
Second Address | Bangor, ME 04401-2311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2018 |
Last Update Date | 04/02/2022 |