Individual
JEREMY MATTHEW CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC
Contact information
Practice address
629 MAIN ST, BANGOR, ME 04401-6848
(207) 990-2870
Mailing address
629 MAIN ST, BANGOR, ME 04401-6848
(207) 990-2870
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CAC4227
ME
Other
Enumeration date
12/02/2010
Last updated
12/02/2010
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