Organization
INDEPENDENCE PROJECT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID EDWARD PELKEY LADC (ADMINISTRATOR/MEMBER/OWNER)
(207) 945-9777
Entity
Organization
Contact information
Practice address
96 HARLOW ST, SUITE 340, BANGOR, ME 04401-4925
(207) 945-9777
(207) 945-9777
Mailing address
96 HARLOW ST, SUITE 340, BANGOR, ME 04401-4925
(207) 945-9777
(207) 945-9777
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
467117
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
431482300
—
ME
Enumeration date
01/26/2009
Last updated
01/27/2009
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