Provider Demographics
NPI:1952781239
Name:BOUILLION, BARRY JAMES JR (LPC)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:JAMES
Last Name:BOUILLION
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 KNOTTS CIR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4569
Mailing Address - Country:US
Mailing Address - Phone:601-398-6797
Mailing Address - Fax:
Practice Address - Street 1:3380 TRICKUM RD BLDG 700
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3680
Practice Address - Country:US
Practice Address - Phone:601-398-6797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1970101YP2500X
GALPC009670101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional