Healthcare Provider Details

I. General information

NPI: 1588234454
Provider Name (Legal Business Name): GRACE JESSICA EYE LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 FRANKLIN ST STE 3H
BANGOR ME
04401-4973
US

IV. Provider business mailing address

128 BENNOCH RD
ORONO ME
04473-3616
US

V. Phone/Fax

Practice location:
  • Phone: 774-473-9596
  • Fax:
Mailing address:
  • Phone: 207-991-8937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC8056
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: