Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003124983 |
---|---|
Provider Name | William Costa |
First Address | Presque Isle, ME 04769-3183 |
Second Address | Marshfield, ME 04654-5045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2010 |
Last Update Date | 02/02/2021 |