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General NPI Number Information
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NPI Number | 1922963594
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Entity Type | Individual
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Provider Name | SHANE CHRISTOPHER GRAY CADC
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Gender | Male
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Dates
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Enumeration Date | 12/17/2025
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 659 HOGAN RD
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City | BANGOR
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State | ME
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Zip | 04401-3626
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Country | US
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Telephone | 207-973-0400
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Fax | 207-973-1881
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Provider Business Mailing Address
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Address Line | 194 GRIFFIN RD APT 606
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City | BANGOR
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State | ME
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Zip | 04401-2841
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Country | US
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Telephone | 207-973-0400
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Fax | 207-973-1881
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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 | CAC9159
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License Number State | ME
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