Healthcare Provider Details

I. General information

NPI: 1124481114
Provider Name (Legal Business Name): JAMES WESLEY UPTON CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 AIRPORT RD
WATERVILLE ME
04901-4524
US

IV. Provider business mailing address

40 AIRPORT RD
WATERVILLE ME
04901-4524
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-7272
  • Fax: 78-720-6392
Mailing address:
  • Phone: 207-872-7272
  • Fax: 207-872-0639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAC6748
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: