Individual
JANE MARIE IRISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
253-255 HAMMOND ST., BANGOR, ME 04401
(207) 478-9613
Mailing address
61 MAIN ST, BANGOR, ME 04401-6397
(207) 478-9613
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LC4893
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
434381199
—
ME
Enumeration date
08/06/2009
Last updated
11/07/2016
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