Provider Demographics
NPI:1932419389
Name:CRITTENDON, JULIE ANA (PHD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANA
Last Name:CRITTENDON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANA
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:226 CREEKSTONE RDG
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3732
Mailing Address - Country:US
Mailing Address - Phone:470-228-2040
Mailing Address - Fax:
Practice Address - Street 1:226 CREEKSTONE RDG
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3732
Practice Address - Country:US
Practice Address - Phone:470-228-2040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2928103TC0700X
1-11-9444103K00000X
GAPSY003968103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003177344AMedicaid