Individual
MR. CHARLES H GARDNER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
1012 UNION ST, BANGOR, ME 04401-3060
(207) 945-5247
Mailing address
PO BOX 1599, BANGOR, ME 04402-1599
(207) 945-5247
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LC 5014
ME
104100000X
Social Worker
Primary
MC14888
ME
Other
Enumeration date
03/25/2014
Last updated
07/24/2014
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