Basic Information
| Provider Information | |||||||||
| NPI: | 1699326348 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CALLAWAY | ||||||||
| FirstName: | MARGARET | ||||||||
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| Credential: | LCPC/C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 327 WOODLAND AVE | ||||||||
| Address2: | |||||||||
| City: | OLD TOWN | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044685928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074478718 | ||||||||
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| Practice Location | |||||||||
| Address1: | 268 STILLWATER AVE | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044013945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079736100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2019 | ||||||||
| LastUpdateDate: | 10/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.