Individual
JON D. GALLAGHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
67 EUSTIS PKWY, WATERVILLE, ME 04901-5173
(207) 873-2136
(207) 872-4522
Mailing address
19 MAPLE ST, AUGUSTA, ME 04330-4705
(207) 458-7780
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LC4988
ME
Other
Enumeration date
09/01/2011
Last updated
09/01/2011
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