Healthcare Provider Details

I. General information

NPI: 1235443664
Provider Name (Legal Business Name): BROOKE GOWDY JOHNSON MS,LCPC, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 MILLET ST STE 203
RICHMOND VT
05477-9623
US

IV. Provider business mailing address

36 MAIN ST STE D
KENNEBUNK ME
04043-5000
US

V. Phone/Fax

Practice location:
  • Phone: 207-251-9534
  • Fax:
Mailing address:
  • Phone: 207-370-8329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC8504
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC8504
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI884
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: