Individual
CHARLES J KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCPC-C
Contact information
Practice address
50 MOODY ST, SACO, ME 04072-1536
(800) 434-3000
Mailing address
50 MOODY ST, SACO, ME 04072-1536
(800) 434-3000
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
XL3708
ME
Other
Enumeration date
11/04/2010
Last updated
11/04/2010
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