Provider Demographics
NPI:1407873375
Name:HUCKEBA, JILL (LPC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:HUCKEBA
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 1:1525 MONTICELLO HWY
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:GA
Mailing Address - Zip Code:31032-3119
Mailing Address - Country:US
Mailing Address - Phone:478-986-1691
Mailing Address - Fax:478-741-9033
Practice Address - Street 1:1525 MONTICELLO HWY
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:GA
Practice Address - Zip Code:31032-3119
Practice Address - Country:US
Practice Address - Phone:478-986-1691
Practice Address - Fax:478-741-9033
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003780101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional