Provider Demographics
NPI:1013156389
Name:MCWALTERS, THOMAS LOUIS (LADC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:LOUIS
Last Name:MCWALTERS
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 1:138 HUNT RD
Mailing Address - Street 2:
Mailing Address - City:THORNDIKE
Mailing Address - State:ME
Mailing Address - Zip Code:04986-3147
Mailing Address - Country:US
Mailing Address - Phone:207-649-1762
Mailing Address - Fax:207-568-3676
Practice Address - Street 1:60 FRONT ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6658
Practice Address - Country:US
Practice Address - Phone:207-649-1762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC20101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)