Provider Demographics
NPI:1154490464
Name:SIMPSON, BODHI J (LCPC)
Entity Type:Individual
Prefix:
First Name:BODHI
Middle Name:J
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5923
Mailing Address - Country:US
Mailing Address - Phone:207-873-4253
Mailing Address - Fax:207-872-7548
Practice Address - Street 1:93 SILVER ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5923
Practice Address - Country:US
Practice Address - Phone:207-873-4253
Practice Address - Fax:207-872-7548
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3334101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional