Provider Demographics
NPI:1093860736
Name:WOHL, PETER (LADC)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:WOHL
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 1:309 HUNTER RD
Mailing Address - Street 2:
Mailing Address - City:UNITY
Mailing Address - State:ME
Mailing Address - Zip Code:04988-3603
Mailing Address - Country:US
Mailing Address - Phone:207-624-1867
Mailing Address - Fax:207-621-6228
Practice Address - Street 1:309 HUNTER RD
Practice Address - Street 2:
Practice Address - City:UNITY
Practice Address - State:ME
Practice Address - Zip Code:04988-3603
Practice Address - Country:US
Practice Address - Phone:207-624-1867
Practice Address - Fax:207-621-6228
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MELC2233101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME295500099Medicaid
ME010288363OtherTAX ID