Provider Demographics
NPI:1831594548
Name:WARD, JONATHAN D (LCPC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:D
Last Name:WARD
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
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Mailing Address - Street 1:120 TILLSON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-3400
Mailing Address - Country:US
Mailing Address - Phone:207-504-7118
Mailing Address - Fax:
Practice Address - Street 1:12 UNION ST
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2739
Practice Address - Country:US
Practice Address - Phone:207-701-4400
Practice Address - Fax:207-701-4487
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MECC4787101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MECC4787OtherSTATE OF MAINE OFFICE OF PROFESSIONAL & FINANCIAL REGULATION