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General NPI Number Information
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NPI Number | 1164590055
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Entity Type | Individual
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Provider Name | JAMES EDWARD DOUGLAS LCPC
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Gender | Male
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 143 POTTLE RD
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City | OXFORD
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State | ME
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Zip | 04270-3362
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Country | US
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Telephone | 207-743-7911
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Fax | 204-743-7913
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Provider Business Mailing Address
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Address Line | 58 HUNTINGTON AVE
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City | NORWAY
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State | ME
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Zip | 04268-5600
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Country | US
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Telephone | 207-743-7114
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CC2736
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License Number State | ME
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