Provider Demographics
NPI:1932288156
Name:DANIE HALE, MARCIA ANNE (LSCW)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:ANNE
Last Name:DANIE HALE
Suffix:
Gender:F
Credentials:LSCW
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:ANNE
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSCW
Mailing Address - Street 1:PO BOX 1237
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402
Mailing Address - Country:US
Mailing Address - Phone:207-942-5055
Mailing Address - Fax:207-942-7013
Practice Address - Street 1:157 PARK ST
Practice Address - Street 2:SUITE 35
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-942-5055
Practice Address - Fax:207-942-7013
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC1058101YA0400X
MELC76991041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME245530099Medicaid
ME245530099Medicaid