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Individual

MR. TRISTAN OLIVER GREENLAW

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LCPC

Contact information

Practice address
61 MAIN ST STE 62, BANGOR, ME 04401-6469
(207) 922-2158
Mailing address
155 COURT ST, BANGOR, ME 04401-4725
(207) 922-7572

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
XL5121
ME
101YP2500X
Professional Counselor
Primary
CC6591
ME

Other

Enumeration date
09/17/2018
Last updated
02/08/2024
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