Provider Demographics
NPI:1306405451
Name:TIBBETTS, JULIE ELISE (LPC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ELISE
Last Name:TIBBETTS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:TIBBETTS
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3015 VETERANS PKWY S
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31788-6705
Mailing Address - Country:US
Mailing Address - Phone:229-985-4815
Mailing Address - Fax:
Practice Address - Street 1:3615B MIKE PADGETT HWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-3898
Practice Address - Country:US
Practice Address - Phone:229-326-0543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10147101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional