Healthcare Provider Details

I. General information

NPI: 1629967237
Provider Name (Legal Business Name): ASHLEIGH BRYANNA BONE LCPC-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 COLLEGE AVE
WATERVILLE ME
04901-6100
US

IV. Provider business mailing address

28 FOREST AVE APT 2
BANGOR ME
04401-5982
US

V. Phone/Fax

Practice location:
  • Phone: 207-680-2065
  • Fax:
Mailing address:
  • Phone: 207-573-8182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberXL8174
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: