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General NPI Number Information
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NPI Number | 1003393042
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Entity Type | Individual
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Provider Name | EMILY A GOODE LCPC
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Gender | Female
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Dates
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Enumeration Date | 07/23/2018
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 86 DAVIS RD
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City | BANGOR
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State | ME
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Zip | 04401-2311
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Country | US
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Telephone | 207-992-2205
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Fax | 207-992-2207
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Provider Business Mailing Address
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Address Line | PO BOX 1599
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City | BANGOR
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State | ME
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Zip | 04402-1599
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Country | US
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Telephone | 207-404-8100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | ME
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