Provider Demographics
NPI:1710317078
Name:COKER, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:COKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 RIMINGTON LN
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2129
Mailing Address - Country:US
Mailing Address - Phone:678-617-9204
Mailing Address - Fax:
Practice Address - Street 1:10 N CLARENDON AVE STE B
Practice Address - Street 2:
Practice Address - City:AVONDALE ESTATES
Practice Address - State:GA
Practice Address - Zip Code:30002-1165
Practice Address - Country:US
Practice Address - Phone:678-617-9204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-22
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007558101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional