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General NPI Number Information
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NPI Number | 1134664287
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Entity Type | Individual
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Provider Name | JAMIE ROSE LCPC-C, NCC
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Gender | Female
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Dates
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Enumeration Date | 12/28/2016
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Last Update Date | 12/28/2016
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Provider Practice Location Address
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Address Line | 280B GANNETT DR
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-6940
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Country | US
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Telephone | 207-828-0048
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Fax |
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Provider Business Mailing Address
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Address Line | 112 SUMMIT TER APT 70
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-2272
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | XL4831
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License Number State | ME
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