Provider Demographics
NPI:1518577683
Name:GOMEZ, JULIE ANNA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANNA
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2000 PROFESSIONAL PKWY
Mailing Address - Street 2:# 200
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4093
Mailing Address - Country:US
Mailing Address - Phone:770-517-8788
Mailing Address - Fax:770-517-0250
Practice Address - Street 1:1200 BALD RIDGE MARINA RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-8526
Practice Address - Country:US
Practice Address - Phone:706-216-2771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0071021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical