Healthcare Provider Details

I. General information

NPI: 1194136325
Provider Name (Legal Business Name): CHARLES LEMIEUX
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 STATE RD
PLYMOUTH MA
02360-5133
US

IV. Provider business mailing address

235 MILLER ST
MIDDLEBORO MA
02346-3137
US

V. Phone/Fax

Practice location:
  • Phone: 508-224-7701
  • Fax:
Mailing address:
  • Phone: 508-947-3685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: