Healthcare Provider Details

I. General information

NPI: 1205915949
Provider Name (Legal Business Name): TIMSON JOHN LATIMER L.M.H.C., L.A.D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 S MAIN ST
MIDDLEBORO MA
02346-2123
US

IV. Provider business mailing address

16 FULLER DR
PLYMOUTH MA
02360-1214
US

V. Phone/Fax

Practice location:
  • Phone: 508-947-6100
  • Fax:
Mailing address:
  • Phone: 508-224-5197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1111
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5388
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: