Provider Demographics
NPI:1750333647
Name:BIGELOW, DAVID ARTWELL (MA LADC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ARTWELL
Last Name:BIGELOW
Suffix:
Gender:M
Credentials:MA LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 KELLOGG ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4370
Mailing Address - Country:US
Mailing Address - Phone:207-774-7213
Mailing Address - Fax:
Practice Address - Street 1:142 HIGH ST
Practice Address - Street 2:628
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2851
Practice Address - Country:US
Practice Address - Phone:207-874-0687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC1824101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)