Healthcare Provider Details

I. General information

NPI: 1720399124
Provider Name (Legal Business Name): PATRICIA JOLLOTTA LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA AYERS

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 04/09/2024
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 PALMER ST
CALAIS ME
04619-1300
US

IV. Provider business mailing address

180 ACADEMY ST STE 3
PRESQUE ISLE ME
04769-3183
US

V. Phone/Fax

Practice location:
  • Phone: 207-454-0270
  • Fax: 72-454-0232
Mailing address:
  • Phone: 207-554-2352
  • Fax: 907-543-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCC6159
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number666
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: