Provider Demographics
NPI:1437297702
Name:JURSA, PAULA J (LCPC-C, LADC, CCS)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:J
Last Name:JURSA
Suffix:
Gender:F
Credentials:LCPC-C, LADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 LISBON ST
Mailing Address - Street 2:SUITE 606
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7247
Mailing Address - Country:US
Mailing Address - Phone:207-333-7140
Mailing Address - Fax:
Practice Address - Street 1:145 LISBON ST
Practice Address - Street 2:SUITE 606
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7247
Practice Address - Country:US
Practice Address - Phone:207-333-7141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC2729101YA0400X
MEXL2968101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME412220099Medicaid
ME201215OtherANTHEM BEHV HEALTH