Individual
AMY RICHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
629 MAIN ST, BANGOR, ME 04401-6848
(207) 990-2870
(207) 990-2298
Mailing address
285 ESSEX ST, BANGOR, ME 04401-4002
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CAC4615
ME
Other
Enumeration date
03/22/2010
Last updated
03/22/2010
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