Provider Demographics
NPI:1942533146
Name:CARLSON, JESSICA C (LCPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:C
Last Name:CARLSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:C
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:PO BOX 10187
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12201-5187
Mailing Address - Country:US
Mailing Address - Phone:207-777-4111
Mailing Address - Fax:207-783-6660
Practice Address - Street 1:75 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6031
Practice Address - Country:US
Practice Address - Phone:207-795-4180
Practice Address - Fax:207-753-6419
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3275101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional