Healthcare Provider Details

I. General information

NPI: 1164473930
Provider Name (Legal Business Name): DONALD EARL CARSON JR. LADC, LCSW, CCS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 VAN BUREN RD VETERANS CLINIC
CARIBOU ME
04736-3567
US

IV. Provider business mailing address

9 ELMWOOD AVE
CARIBOU ME
04736-2746
US

V. Phone/Fax

Practice location:
  • Phone: 207-498-8785
  • Fax:
Mailing address:
  • Phone: 207-498-2755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLC1445
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCCS3152
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC1241
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: