Provider Demographics
NPI:1184208852
Name:AHEARN, SAMANTHA LEE (CADC)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LEE
Last Name:AHEARN
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:LEE
Other - Last Name:GODIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:689 ODLIN RD
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6709
Mailing Address - Country:US
Mailing Address - Phone:207-947-6800
Mailing Address - Fax:
Practice Address - Street 1:689 ODLIN RD
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6709
Practice Address - Country:US
Practice Address - Phone:207-947-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC6781101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)