Organization
FULL CIRCLE WELLNESS CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARCIA ANNE GRAY LCSW (EXECUTIVE DIRECTOR)
(207) 942-5055
Entity
Organization
Contact information
Practice address
265 HAMMOND ST, BANGOR, ME 04401-4610
(207) 942-5055
(207) 942-7013
Mailing address
PO BOX 1237, BANGOR, ME 04402-1237
(207) 942-5055
(207) 942-7013
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
103TC0700X
Clinical Psychologist
—
—
103TF0200X
Forensic Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
432502100
—
ME
05
—
432502101
—
ME
Enumeration date
08/30/2006
Last updated
09/19/2013
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