Provider Demographics
NPI:1295347482
Name:PUCKETT, JULIE (LPC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7445 MATTS LANDING PT
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-4740
Mailing Address - Country:US
Mailing Address - Phone:678-793-6116
Mailing Address - Fax:
Practice Address - Street 1:7445 MATTS LANDING PT
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30028-4740
Practice Address - Country:US
Practice Address - Phone:678-793-6116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003579101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional