Basic Information
| Provider Information | |||||||||
| NPI: | 1851872006 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ATKINSON | ||||||||
| FirstName: | JORDAN | ||||||||
| MiddleName: | DAVIS | ||||||||
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| Credential: | LCPC-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 67 EUSTIS PKWY | ||||||||
| Address2: | |||||||||
| City: | WATERVILLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049015173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078732136 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 58 DRUMMOND AVE | ||||||||
| Address2: | |||||||||
| City: | WATERVILLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078730695 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2018 | ||||||||
| LastUpdateDate: | 08/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | XL5150 | ME | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.