Provider Demographics
NPI:1558396226
Name:BISSELL, KRISTINA M (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:BISSELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:M
Other - Last Name:MCCORRISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1599
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-1599
Mailing Address - Country:US
Mailing Address - Phone:207-992-2601
Mailing Address - Fax:207-404-8351
Practice Address - Street 1:992 UNION ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3057
Practice Address - Country:US
Practice Address - Phone:207-992-2601
Practice Address - Fax:207-404-8351
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC102301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical