Provider Demographics
NPI:1720399124
Name:JOLLOTTA, PATRICIA (LCPC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:JOLLOTTA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:AYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:180 ACADEMY ST STE 3
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-3183
Mailing Address - Country:US
Mailing Address - Phone:207-554-2352
Mailing Address - Fax:907-543-7101
Practice Address - Street 1:127 PALMER ST
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1300
Practice Address - Country:US
Practice Address - Phone:207-454-0270
Practice Address - Fax:072-454-0232
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101YA0400X
AK666101YP2500X
MECC6159101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1006017Medicaid
AK1020986Medicaid
AK1584987Medicaid