Individual
MR. CARROLL L ACKLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC, CCS
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
LC1222
ME
Other
Enumeration date
12/15/2014
Last updated
12/15/2014
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