Individual provider Active NPI

Diane M Hall, LCPC

  • Mental Health Counselor
  • Bangor, ME
National Provider Identifier
1356660377
Registry record updated May 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
CC2063 Issued in ME
Practice address
6 Telcom Dr
Bangor, ME 04401-3072
Phone
(207) 947-0147
Fax
(207) 990-3365
NPI assigned
Jun 1, 2010
Last updated
May 4, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 4, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X CC2063 ME Primary

Addresses

Primary practice location

6 Telcom Dr
Bangor, ME 04401-3072

Mailing address

PO Box 1599
Bangor, ME 04402-1599
Phone (207) 404-8200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240110002472 ME Practitioner - Mental Health Counselor 4082065479 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CC2063MEMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Penobscot Community Health Center CurrentSince Jan 1, 2024 Accepting new patients
Penobscot Community Health Center CurrentSince Jan 1, 2024 Accepting new patients
Penobscot Community Health Center Past Accepting new patients
Penobscot Community Health Center Past Accepting new patients

Locations

1012 Union St
Ste 1
Bangor, ME 04401
Phone 2079455247407

1068 Union St
Bangor, ME 04401
Phone (207) 404-8181

6 Telcom Dr
Bangor, ME 04401
Phone (207) 941-2850

6 Telcom Dr
Fl 2
Bangor, ME 04401
Phone (207) 947-0147

29 Schoodic Dr
Belfast, ME 04915
Phone (207) 218-6001

53 Schoodic Dr
Belfast, ME 04915
Phone (207) 338-6900

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1275350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620086400000",
    "number": "1356660377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1599",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044021599",
            "telephone_number": "207-404-8200",
            "fax_number": "207-947-0435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 TELCOM DR",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013072",
            "telephone_number": "207-947-0147",
            "fax_number": "207-990-3365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALL",
        "first_name": "DIANE",
        "middle_name": "M",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-01",
        "last_updated": "2021-05-04",
        "certification_date": "2021-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ME",
            "license": "CC2063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.