Healthcare Provider Details

I. General information

NPI: 1699198630
Provider Name (Legal Business Name): JAIMIE LYNN PERRY-HUDSON LCPC-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2014
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 TRAYNOR ST APT 4
OLD ORCHARD BEACH ME
04064-2956
US

IV. Provider business mailing address

10 TRAYNOR ST APT 4
OLD ORCHARD BEACH ME
04064-2956
US

V. Phone/Fax

Practice location:
  • Phone: 207-906-6986
  • Fax:
Mailing address:
  • Phone: 207-906-6986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberXL4303
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: