Provider Demographics
NPI:1295734085
Name:DIRIGO COUNSELING CLINIC, LLC
Entity type:Organization
Organization Name:DIRIGO COUNSELING CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALGEE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, CCS, SAP
Authorized Official - Phone:207-973-0505
Mailing Address - Street 1:557 HAMMOND ST
Mailing Address - Street 2:BANGOR
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4511
Mailing Address - Country:US
Mailing Address - Phone:207-973-0505
Mailing Address - Fax:207-942-2175
Practice Address - Street 1:557 HAMMOND ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4511
Practice Address - Country:US
Practice Address - Phone:207-973-0505
Practice Address - Fax:207-942-2175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2016-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME527039101YP2500X, 251S00000X
ME600402101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432471100Medicaid
ME432471100Medicaid