Individual
BETHANIE JACQUES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
741 WARREN AVE, PORTLAND, ME 04103-1007
(207) 879-6165
(207) 879-7466
Mailing address
PO BOX 150, WESTBROOK, ME 04098-0150
(207) 879-6165
(207) 879-7466
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
CC4878
ME
101YP2500X
Professional Counselor
XL3960
ME
Other
Enumeration date
05/18/2012
Last updated
07/24/2022
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