Provider Demographics
NPI:1699198630
Name:PERRY-HUDSON, JAIMIE LYNN (LCPC-C)
Entity Type:Individual
Prefix:
First Name:JAIMIE
Middle Name:LYNN
Last Name:PERRY-HUDSON
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 TRAYNOR ST APT 4
Mailing Address - Street 2:
Mailing Address - City:OLD ORCHARD BEACH
Mailing Address - State:ME
Mailing Address - Zip Code:04064-2956
Mailing Address - Country:US
Mailing Address - Phone:207-906-6986
Mailing Address - Fax:
Practice Address - Street 1:10 TRAYNOR ST APT 4
Practice Address - Street 2:
Practice Address - City:OLD ORCHARD BEACH
Practice Address - State:ME
Practice Address - Zip Code:04064-2956
Practice Address - Country:US
Practice Address - Phone:207-906-6986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-28
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4303101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional