Healthcare Provider Details

I. General information

NPI: 1912010364
Provider Name (Legal Business Name): JILL M COPELAND LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ROUTE 1 SUITE 29C
YARMOUTH ME
04096-4711
US

IV. Provider business mailing address

500 ROUTE 1 SUITE 29C
YARMOUTH ME
04096-4711
US

V. Phone/Fax

Practice location:
  • Phone: 207-749-6803
  • Fax: 207-688-4561
Mailing address:
  • Phone: 207-749-6803
  • Fax: 207-688-4561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC1852
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: