Provider Demographics
NPI:1952751356
Name:COOMBS, CHAD (CADC)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:COOMBS
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 RUSSELL HILL RD
Mailing Address - Street 2:
Mailing Address - City:BUCKSPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04416-4803
Mailing Address - Country:US
Mailing Address - Phone:207-217-8796
Mailing Address - Fax:
Practice Address - Street 1:36 RUSSELL HILL RD
Practice Address - Street 2:
Practice Address - City:BUCKSPORT
Practice Address - State:ME
Practice Address - Zip Code:04416-4803
Practice Address - Country:US
Practice Address - Phone:207-217-8796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC5444101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)