Provider Demographics
NPI:1659679355
Name:DOUBLE, BRYAN J (LCPC)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:J
Last Name:DOUBLE
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 AUSTIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04736
Mailing Address - Country:US
Mailing Address - Phone:207-484-8147
Mailing Address - Fax:
Practice Address - Street 1:5 AUSTIN DR
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04473-3603
Practice Address - Country:US
Practice Address - Phone:207-484-8147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health