Provider Demographics
NPI:1104235928
Name:CHURCHILL, WILLIAM H (LADC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:CHURCHILL
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 1:145 LISBON ST STE 507
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7241
Mailing Address - Country:US
Mailing Address - Phone:207-333-8873
Mailing Address - Fax:
Practice Address - Street 1:145 LISBON ST STE 507
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7241
Practice Address - Country:US
Practice Address - Phone:207-333-8873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC6194101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)