Healthcare Provider Details

I. General information

NPI: 1598953697
Provider Name (Legal Business Name): VICTORIA AMANDA KUGEL LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 EXCHANGE ST
BANGOR ME
04401-6507
US

IV. Provider business mailing address

PO BOX 1788
BANGOR ME
04402-1788
US

V. Phone/Fax

Practice location:
  • Phone: 207-944-5333
  • Fax: 207-433-1025
Mailing address:
  • Phone: 207-944-5333
  • Fax: 207-433-1025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC2264
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: