Healthcare Provider Details

I. General information

NPI: 1528014917
Provider Name (Legal Business Name): BRANDIN TURNER LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 PARK ST
SOUTH PARIS ME
04281-6438
US

IV. Provider business mailing address

PO BOX 186
SOUTH GARDINER ME
04359-0186
US

V. Phone/Fax

Practice location:
  • Phone: 207-739-2644
  • Fax:
Mailing address:
  • Phone: 207-446-8207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAC3135
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLC3946
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: