Provider Demographics
NPI:1568145282
Name:SIWICKI, JULIANN ELIZABETH (LGPC)
Entity Type:Individual
Prefix:MRS
First Name:JULIANN
Middle Name:ELIZABETH
Last Name:SIWICKI
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5116 DORSEY HALL DR STE B
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7877
Mailing Address - Country:US
Mailing Address - Phone:410-995-8274
Mailing Address - Fax:
Practice Address - Street 1:5116 DORSEY HALL DR STE B
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7877
Practice Address - Country:US
Practice Address - Phone:410-995-8274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP14085101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty