Provider Demographics
NPI:1952615601
Name:CHARLES, JULIE LAVAUGHN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:LAVAUGHN
Last Name:CHARLES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-2425
Mailing Address - Country:US
Mailing Address - Phone:404-321-6111
Mailing Address - Fax:404-417-2986
Practice Address - Street 1:180 MARTIN DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-2425
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:404-417-2986
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACWS0056411041C0700X
TX538501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical