Provider Demographics
NPI:1649636358
Name:GWYNN, JULIA (MA, LPC-I)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:GWYNN
Suffix:
Gender:F
Credentials:MA, LPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-6069
Mailing Address - Country:US
Mailing Address - Phone:843-304-5857
Mailing Address - Fax:
Practice Address - Street 1:180 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29909-6069
Practice Address - Country:US
Practice Address - Phone:843-304-5857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6879101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional