Provider Demographics
NPI:1437297702
Name:JURSA, PAULA J (LCPC, LADC, CCS)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:J
Last Name:JURSA
Suffix:
Gender:F
Credentials:LCPC, LADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WALES RD
Mailing Address - Street 2:
Mailing Address - City:SABATTUS
Mailing Address - State:ME
Mailing Address - Zip Code:04280-4136
Mailing Address - Country:US
Mailing Address - Phone:207-440-4875
Mailing Address - Fax:
Practice Address - Street 1:17 WALES RD
Practice Address - Street 2:
Practice Address - City:SABATTUS
Practice Address - State:ME
Practice Address - Zip Code:04280-4136
Practice Address - Country:US
Practice Address - Phone:207-440-4875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2025-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC2729101YA0400X
MECC3406101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME201215OtherANTHEM BEHV HEALTH
ME412220099Medicaid