Healthcare Provider Details

I. General information

NPI: 1437135704
Provider Name (Legal Business Name): NANCY LOUISE JOHNSON L.C.S.W, CAC, CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY LOUISE MARION LCSW, CAC, CSAC

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VA CTR BUILDING 206
AUGUSTA ME
04330-6719
US

IV. Provider business mailing address

1 VA CTR BUILDING 206
AUGUSTA ME
04330-6719
US

V. Phone/Fax

Practice location:
  • Phone: 207-623-8411
  • Fax: 207-623-5791
Mailing address:
  • Phone: 207-623-8411
  • Fax: 207-623-5791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number89215
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710000655
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904003420
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC14026
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: