Healthcare Provider Details

I. General information

NPI: 1437297702
Provider Name (Legal Business Name): PAULA J JURSA LCPC, LADC, CCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 11/15/2025
Certification Date: 11/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 WALES RD
SABATTUS ME
04280-4136
US

IV. Provider business mailing address

17 WALES RD
SABATTUS ME
04280-4136
US

V. Phone/Fax

Practice location:
  • Phone: 207-440-4875
  • Fax:
Mailing address:
  • Phone: 207-440-4875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLC2729
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC3406
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: