Provider Demographics
NPI:1184076481
Name:BLUM, JILLIAN (LPC)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:BLUM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3442 KENSINGTON PARC CIR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE ESTATES
Mailing Address - State:GA
Mailing Address - Zip Code:30002-1779
Mailing Address - Country:US
Mailing Address - Phone:770-361-4627
Mailing Address - Fax:770-995-1959
Practice Address - Street 1:165 DEKALB INDUSTRIAL WAY STE B8
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2230
Practice Address - Country:US
Practice Address - Phone:770-361-4627
Practice Address - Fax:770-995-1959
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008814101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional