# FULL CIRCLE WELLNESS CENTER, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659481786
- **Authorized official:** MARCIA ANNE GRAY LCSW (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (207) 942-5055

## Contact information

- **Practice address:** 265 HAMMOND ST, BANGOR, ME 04401-4610
- **Practice address phone:** (207) 942-5055
- **Practice address fax:** (207) 942-7013
- **Mailing address:** PO BOX 1237, BANGOR, ME 04402-1237
- **Mailing address phone:** (207) 942-5055
- **Mailing address fax:** (207) 942-7013

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |
| 101YP2500X | Professional Counselor | — | NULL | — |
| 101YP2500X | Professional Counselor | — | — | — |
| 103TC0700X | Clinical Psychologist | — | NULL | — |
| 103TC0700X | Clinical Psychologist | — | — | — |
| 103TF0200X | Forensic Psychologist | — | NULL | — |
| 103TF0200X | Forensic Psychologist | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |

## Other

- **Enumeration date:** 08/30/2006
- **Last updated:** 09/19/2013