Provider Demographics
NPI:1750790861
Name:MCKAY, JAMIE (LADC, CCS, LSW)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:
Last Name:MCKAY
Suffix:
Gender:F
Credentials:LADC, CCS, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 HOGAN RD
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3626
Mailing Address - Country:US
Mailing Address - Phone:207-973-0400
Mailing Address - Fax:207-973-1881
Practice Address - Street 1:659 HOGAN RD
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3626
Practice Address - Country:US
Practice Address - Phone:207-973-0400
Practice Address - Fax:207-973-1881
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4287101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)