Provider Demographics
NPI:1649337197
Name:CHARLOTTE WHITE CENTER
Entity type:Organization
Organization Name:CHARLOTTE WHITE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-564-2464
Mailing Address - Street 1:PO BOX 380
Mailing Address - Street 2:572 BANGOR ROAD
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-0380
Mailing Address - Country:US
Mailing Address - Phone:207-564-2464
Mailing Address - Fax:204-564-2404
Practice Address - Street 1:59 RIVER ST
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1322
Practice Address - Country:US
Practice Address - Phone:207-564-2464
Practice Address - Fax:207-564-2404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder