Doctor Name: | JUSTIN MICHAUD |
NPI Number: | 1023400231 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | XL4461 |
Business Practice Address: | 268 Stillwater Ave Bangor, ME - 044013945 |
Business Phone Number: | 2079736044 |
Business Fax Number: | |
Mailing Address: | 268 Stillwater Ave, BANGOR |
State: | ME |
Postal Code: | 044013945 |
Phone Number: | 2079736044 |
Fax Number: | |
NPI Enumeration Date: | 02/25/2015 |
NPI Last Update Date: | 02/25/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | XL4461 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |