=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174323562
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY JANE HILL LCPC CONDITIONAL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2025
-----------------------------------------------------
Last Update Date | 03/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 STATE ST STE 613
-----------------------------------------------------
City | BANGOR
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04401-5140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-307-7704
-----------------------------------------------------
Fax | 207-573-1108
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 25
-----------------------------------------------------
City | VAN BUREN
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04785-0025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-484-8453
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | XL8029
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------