Individual
MS. CAROL JEAN WITHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MHRT-C
Contact information
Practice address
273 HAMMOND ST, BANGOR, ME 04401-4610
(207) 217-6711
(207) 217-6712
Mailing address
273 HAMMOND ST, BANGOR, ME 04401-4610
(207) 217-6711
(207) 217-6712
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
MHRT-C
ME
Other
Enumeration date
07/28/2010
Last updated
10/01/2010
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