Provider Demographics
NPI:1710933973
Name:STILL, JUDITH SHERON (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:SHERON
Last Name:STILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SHERON
Other - Middle Name:CRAFT
Other - Last Name:STILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:123 AVONDALE DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-4009
Mailing Address - Country:US
Mailing Address - Phone:706-733-0188
Mailing Address - Fax:706-481-6786
Practice Address - Street 1:1 FREEDOM WAY
Practice Address - Street 2:28RU
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6258
Practice Address - Country:US
Practice Address - Phone:706-733-0188
Practice Address - Fax:706-481-6786
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA0007341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical