Individual
COLLEEN JILLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, LADC, CCS
Contact information
Practice address
86 TANDBERG TRL, WINDHAM, ME 04062-5841
(207) 893-0386
Mailing address
PO BOX 1360, WINDHAM, ME 04062-1360
(207) 893-0386
(207) 893-2086
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LC4982
ME
1041C0700X
Clinical Social Worker
Primary
LC17006
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1851665939
—
ME
01
—
E400450569
MEDICARE
ME
Enumeration date
03/07/2012
Last updated
03/20/2018
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