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NPI Code Detail

MEDICARE: DR. JILL D. MCCOLLUM PHD - LCPC

MEDICARE: DR. JILL D. MCCOLLUM PHD - LCPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorCC2230ME

General Provider Information

NPI Number : 1467518415
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JILL D. MCCOLLUM PHD - LCPC
Provider Business Mailing Address
First Line : 650 ISLAND AVE
Second Line :
City : LONG ISLAND
State : ME
Zip : 04050-3311
Country : US
Telephone Number : 207-799-9600
Fax Number : 207-799-9600
Provider Business Practice Location Address
First Line : 1396 BROADWAY
Second Line :
City : SOUTH PORTLAND
State : ME
Zip : 04106-4111
Country : US
Telephone Number : 207-799-9600
Fax Number : 207-799-9600
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2006
Last Update Date : 07/08/2007

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