Healthcare Provider Details

I. General information

NPI: 1821383225
Provider Name (Legal Business Name): RONDA L SAVAGE LCPC/C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 CEDAR ST
BANGOR ME
04401-6433
US

IV. Provider business mailing address

PO BOX 425
BANGOR ME
04402-0425
US

V. Phone/Fax

Practice location:
  • Phone: 207-947-0366
  • Fax: 207-942-4350
Mailing address:
  • Phone: 207-947-0366
  • Fax: 207-942-4350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberXL4647
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: