Healthcare Provider Details

I. General information

NPI: 1225792526
Provider Name (Legal Business Name): AARON THOMAS JOHNSON LADC, CCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 BATH RD
BRUNSWICK ME
04011-2673
US

IV. Provider business mailing address

329 BATH RD
BRUNSWICK ME
04011-2673
US

V. Phone/Fax

Practice location:
  • Phone: 207-205-4437
  • Fax:
Mailing address:
  • Phone: 207-205-4437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLC8766
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: