Provider Demographics
NPI:1528014917
Name:TURNER, BRANDIN (LADC)
Entity Type:Individual
Prefix:
First Name:BRANDIN
Middle Name:
Last Name:TURNER
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:SOUTH GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04359-0186
Mailing Address - Country:US
Mailing Address - Phone:207-446-8207
Mailing Address - Fax:
Practice Address - Street 1:659 PARK ST
Practice Address - Street 2:
Practice Address - City:SOUTH PARIS
Practice Address - State:ME
Practice Address - Zip Code:04281-6438
Practice Address - Country:US
Practice Address - Phone:207-739-2644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC3135101YA0400X
MELC3946101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431875699Medicaid