Provider Demographics
NPI:1154690345
Name:EVANS, JULIE RENEE (LPC)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:RENEE
Last Name:EVANS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:FOX
Other - Last Name:DURDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:410 MURRY PARK
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-2622
Mailing Address - Country:US
Mailing Address - Phone:770-710-2173
Mailing Address - Fax:855-817-2428
Practice Address - Street 1:820 EBENEZER CHURCH RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SHARPSBURG
Practice Address - State:GA
Practice Address - Zip Code:30277-2073
Practice Address - Country:US
Practice Address - Phone:404-960-1282
Practice Address - Fax:855-817-2428
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC002868101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000601609MMedicaid
GA003177202AMedicaid
GAGRP2054Medicare PIN