Provider Demographics
NPI:1952725699
Name:ACKERMAN, JULIE SMITH (LISW CP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:SMITH
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:LISW CP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:SMITH
Other - Last Name:GUIDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3580 JOSEPH SIEWICK DR STE 5
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1717
Mailing Address - Country:US
Mailing Address - Phone:703-391-4574
Mailing Address - Fax:
Practice Address - Street 1:1320 MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3266
Practice Address - Country:US
Practice Address - Phone:657-237-2450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040084871041C0700X
SC158391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical