Provider Demographics
NPI:1083993513
Name:MARQUIS, JULIE SUSAN (LADC, CCS)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:SUSAN
Last Name:MARQUIS
Suffix:
Gender:F
Credentials:LADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 STATE ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5103
Mailing Address - Country:US
Mailing Address - Phone:207-852-4706
Mailing Address - Fax:
Practice Address - Street 1:15 STATE ST
Practice Address - Street 2:SUITE 303
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5103
Practice Address - Country:US
Practice Address - Phone:207-852-4706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC2227101YA0400X
MECCS3348101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)