Individual
JILL SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
181 BRACKETT ST, PORTLAND, ME 04102-3857
(207) 775-0105
Mailing address
181 BRACKETT ST, PORTLAND, ME 04102-3857
(207) 775-0105
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
CC246
ME
Other
Enumeration date
12/29/2011
Last updated
12/29/2011
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