Individual
MARY D MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1012 UNION ST, BANGOR, ME 04401-3060
(207) 945-5247
(207) 990-1248
Mailing address
PO BOX 1599, BANGOR, ME 04402-1599
(207) 945-5247
(207) 947-0435
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LC1351
ME
101YM0800X
Mental Health Counselor
Primary
LC12013
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
432238199
—
ME
Enumeration date
08/06/2009
Last updated
05/05/2021
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