Doctor Name: | JON D. GALLAGHER |
NPI Number: | 1134400369 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LADC |
License Number: | LC4988 |
Business Practice Address: | 67 Eustis Pkwy Waterville, ME - 049015173 |
Business Phone Number: | 2078732136 |
Business Fax Number: | 2078724522 |
Mailing Address: | 19 Maple St, AUGUSTA |
State: | ME |
Postal Code: | 043304705 |
Phone Number: | 2074587780 |
Fax Number: | |
NPI Enumeration Date: | 09/01/2011 |
NPI Last Update Date: | 09/01/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | LC4988 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |