Provider Demographics
NPI:1871728618
Name:PELKEY, DAVID E (LADC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:PELKEY
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:96 HARLOW ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4925
Mailing Address - Country:US
Mailing Address - Phone:207-945-9777
Mailing Address - Fax:207-945-9777
Practice Address - Street 1:96 HARLOW ST
Practice Address - Street 2:SUITE 340
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4925
Practice Address - Country:US
Practice Address - Phone:207-945-9777
Practice Address - Fax:207-945-9777
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME516606101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432484399Medicaid