| Doctor Name: | MAXINE WOLPH-JOHNSON |
| NPI Number: | 1194964114 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | LC122 |
| Business Practice Address: | 18 Common St Waterville, ME - 049016678 |
| Business Phone Number: | 2076964225 |
| Business Fax Number: | 2076964211 |
| Mailing Address: | Po Box 288, ANSON |
| State: | ME |
| Postal Code: | 049110288 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 02/14/2009 |
| NPI Last Update Date: | 02/14/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | LC122 |
| 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: | |