Provider Demographics
NPI:1003166158
Name:PERDUE, JULIE ANN (LPC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:PERDUE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5590 CREEK DALE WAY
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-4414
Mailing Address - Country:US
Mailing Address - Phone:405-837-6272
Mailing Address - Fax:
Practice Address - Street 1:5590 CREEK DALE WAY
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-4414
Practice Address - Country:US
Practice Address - Phone:405-837-6272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103K00000X
TX78349101YP2500X
GA012984101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst