Provider Demographics
NPI:1265675961
Name:WILLETT, JULIE K (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:K
Last Name:WILLETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 GRAPEVINE WAY NE
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-6058
Mailing Address - Country:US
Mailing Address - Phone:770-548-8596
Mailing Address - Fax:
Practice Address - Street 1:12 GRAPEVINE WAY NE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121-6058
Practice Address - Country:US
Practice Address - Phone:770-548-8596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0028711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical