Healthcare Provider Details

I. General information

NPI: 1295734085
Provider Name (Legal Business Name): DIRIGO COUNSELING CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 10/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 HAMMOND ST
BANGOR ME
04401-4511
US

IV. Provider business mailing address

557 HAMMOND ST BANGOR
BANGOR ME
04401-4511
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-0505
  • Fax: 207-942-2175
Mailing address:
  • Phone: 207-973-0505
  • Fax: 207-942-2175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number600402
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number527039
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number527039
License Number StateME

VIII. Authorized Official

Name: ALAN ALGEE
Title or Position: EXECUTIVE DIRECTOR
Credential: LCPC, CCS, SAP
Phone: 207-973-0505