Healthcare Provider Details

I. General information

NPI: 1073963427
Provider Name (Legal Business Name): JOYCE DEE WARREN CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 FRANKLIN ST
BANGOR ME
04401-4909
US

IV. Provider business mailing address

442 MOOSEHEAD TRL
NEWPORT ME
04953-4004
US

V. Phone/Fax

Practice location:
  • Phone: 207-907-7205
  • Fax:
Mailing address:
  • Phone: 207-907-7205
  • Fax: 207-561-4725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAC5054
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: