Provider Demographics
NPI:1528434008
Name:COFFIN, MELINDA (BS, CADC)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:COFFIN
Suffix:
Gender:F
Credentials:BS, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 HANCOCK ST STE 2H
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6573
Mailing Address - Country:US
Mailing Address - Phone:207-989-5701
Mailing Address - Fax:207-989-5720
Practice Address - Street 1:304 HANCOCK STREET
Practice Address - Street 2:SUITE 2H
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6541
Practice Address - Country:US
Practice Address - Phone:207-989-5701
Practice Address - Fax:207-989-5720
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC5544101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)