Provider Demographics
NPI:1962645515
Name:RAULERSON, ADAM JACKSON (LMFT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:JACKSON
Last Name:RAULERSON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4331 THURMON TANNER RD
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-2829
Mailing Address - Country:US
Mailing Address - Phone:678-513-5700
Mailing Address - Fax:
Practice Address - Street 1:915 INTERSTATE RIDGE DR
Practice Address - Street 2:SUITE C AND G
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-7076
Practice Address - Country:US
Practice Address - Phone:678-207-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1001106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1114988268Medicaid