Provider Demographics
NPI:1578519245
Name:CONNER COLLINS, JULIA MAC (LPC MAC)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:MAC
Last Name:CONNER COLLINS
Suffix:
Gender:F
Credentials:LPC MAC
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:6605 ABERCORN ST STE 114H
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5815
Mailing Address - Country:US
Mailing Address - Phone:912-480-9984
Mailing Address - Fax:
Practice Address - Street 1:6605 ABERCORN ST STE 114H
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5815
Practice Address - Country:US
Practice Address - Phone:912-480-9984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC 002960101YP2500X
GANAADAC-MAC 507574101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC 002960OtherLICENSE