Individual
MR. MARK ALLEN BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCPC-C
Contact information
Practice address
166 BROADWAY, BANGOR, ME 04401-5208
(207) 947-9630
Mailing address
166 BROADWAY, BANGOR, ME 04401-5208
(207) 992-3036
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
XL4496
ME
Other
Enumeration date
09/06/2017
Last updated
05/01/2018
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