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General NPI Number Information
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NPI Number | 1467518415
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Entity Type | Individual
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Provider Name | JILL D. MCCOLLUM PHD - LCPC
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Gender | Female
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 02/08/2026
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Provider Practice Location Address
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Address Line | 1396 BROADWAY
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-4111
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Country | US
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Telephone | 207-799-9600
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Fax | 207-799-9600
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Provider Business Mailing Address
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Address Line | 650 ISLAND AVE
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City | LONG ISLAND
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State | ME
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Zip | 04050-3311
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Country | US
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Telephone | 207-799-9600
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Fax | 207-799-9600
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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 | CC2230
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License Number State | ME
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