Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | LC127 | ME |
NPI | 1003299264 |
---|---|
Provider Name | Shirley Parker |
First Address | Bowdoinham, ME 04008-4426 |
Second Address | Bowdoinham, ME 04008-4426 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2015 |
Last Update Date | 07/07/2015 |