# WABANAKI PUBLIC HEALTH AND WELLNESS

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

## Provider details

- **NPI number:** 1689335184
- **Authorized official:** SHARON MAE JORDAN LCSW (DIRECTOR)
- **Authorized official phone:** (207) 992-0411

## Contact information

- **Practice address:** 157 PARK ST, BANGOR, ME 04401-5093
- **Practice address phone:** (207) 631-1536
- **Practice address fax:** (207) 631-0524
- **Mailing address:** PO BOX 1356, BANGOR, ME 04402-1356
- **Mailing address phone:** (207) 992-0411
- **Mailing address fax:** (207) 631-0524

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TA0400X | Addiction (Substance Use Disorder) Psychologist | — | NULL | Yes |
| 103TA0400X | Addiction (Substance Use Disorder) Psychologist | — | — | Yes |
| 251B00000X | Case Management Agency | — | NULL | — |
| 251K00000X | Public Health or Welfare Agency | — | NULL | — |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |

## Other

- **Enumeration date:** 01/06/2022
- **Last updated:** 01/06/2022