Provider Demographics
NPI:1861620502
Name:CHAPMAN, CAROL JAMES COOKSON (LCPC, LADC)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:JAMES COOKSON
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:LCPC, LADC
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:JAMES
Other - Last Name:COOKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 234
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-0234
Mailing Address - Country:US
Mailing Address - Phone:207-659-3408
Mailing Address - Fax:
Practice Address - Street 1:115 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4936
Practice Address - Country:US
Practice Address - Phone:207-659-3408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC 3563101YA0400X
MECC4013101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)