| Doctor Name: | TIMOTHY F. GAUTHIER |
| NPI Number: | 1548667645 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CADC |
| License Number: | CAC5134 |
| Business Practice Address: | 474 Main St Springvale, ME - 040831409 |
| Business Phone Number: | 2073241500 |
| Business Fax Number: | 2074905263 |
| Mailing Address: | 78 Atlantic Pl, SOUTH PORTLAND |
| State: | ME |
| Postal Code: | 041062316 |
| Phone Number: | 2078427701 |
| Fax Number: | 2078427773 |
| NPI Enumeration Date: | 12/04/2014 |
| NPI Last Update Date: | 12/04/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | CAC5134 |
| 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: | |