Healthcare Provider Details

I. General information

NPI: 1679232193
Provider Name (Legal Business Name): MANDI LYNN SMILEY CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 HOGAN RD
BANGOR ME
04401-3626
US

IV. Provider business mailing address

2739 ROUTE 2
HERMON ME
04401-0218
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-0400
  • Fax:
Mailing address:
  • Phone: 207-949-5547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAC7777
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: