Provider Demographics
NPI:1972968865
Name:BUCKLAND, JEANA (LCPC)
Entity Type:Individual
Prefix:
First Name:JEANA
Middle Name:
Last Name:BUCKLAND
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:JEANA
Other - Middle Name:
Other - Last Name:BUCKLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:11 POND VIEW DR
Mailing Address - Street 2:
Mailing Address - City:OTISFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04270-6609
Mailing Address - Country:US
Mailing Address - Phone:207-647-5629
Mailing Address - Fax:
Practice Address - Street 1:32 N HIGH ST
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1125
Practice Address - Country:US
Practice Address - Phone:207-647-5629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACC4638101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor