Active NPI
Maxine Wolph-Johnson
- Addiction (Substance Use Disorder) Counselor
- Waterville, ME
National Provider Identifier
1194964114
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- LC122
- Practice address
- 18 Common St
Waterville, ME 04901-6678 - Phone
- (207) 696-4225
- Fax
- (207) 696-4211
- NPI assigned
- Feb 14, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LC122 | ME | Primary |
Addresses
Primary practice location
18 Common St
Waterville, ME 04901-6678
Mailing address
PO Box 288
Anson, ME 04911-0288
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 431821099 | Medicaid | ME |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC122 | ME | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1234569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1234569600000",
"number": "1194964114",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 288",
"city": "ANSON",
"state": "ME",
"postal_code": "049110288"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18 COMMON ST",
"city": "WATERVILLE",
"state": "ME",
"postal_code": "049016678",
"telephone_number": "207-696-4225",
"fax_number": "207-696-4211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLPH-JOHNSON",
"first_name": "MAXINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-02-14",
"last_updated": "2009-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "ME",
"license": "LC122",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "431821099",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waterville, ME
- William E. Bennett, M.D. P.a
- Victoria Paige Wilson Townley, LCSW
- Winslow Public Schools
- Deborah I Witkin, MD
- Steve Richard Witkin, M.D.
- Robin M Wood, M.D.
- Woodlands Senior Living of Madison LLC
- Woodlands Senior Living of Waterville, Inc.
- Woodlands Senior Living of Waterville, Inc.
- Woodlands Senior Living of Waterville, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.