Provider Demographics
NPI:1831416783
Name:CLINICAL CONSULTATION & COUNSELING, P.A.
Entity type:Organization
Organization Name:CLINICAL CONSULTATION & COUNSELING, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:GOOLSBY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-564-0026
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-0370
Mailing Address - Country:US
Mailing Address - Phone:207-564-0026
Mailing Address - Fax:877-822-7919
Practice Address - Street 1:26 RIVER ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1321
Practice Address - Country:US
Practice Address - Phone:207-564-0026
Practice Address - Fax:877-822-7919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431819099Medicaid
MEME1205Medicare PIN