Provider Demographics
NPI:1023516275
Name:CRATE, MICHELLE (LADC, CCS)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CRATE
Suffix:
Gender:F
Credentials:LADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINTERPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04496-3804
Mailing Address - Country:US
Mailing Address - Phone:207-356-1455
Mailing Address - Fax:
Practice Address - Street 1:27 STATE ST STE 51
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5113
Practice Address - Country:US
Practice Address - Phone:207-356-1455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC5704101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)