Provider Demographics
NPI:1962768572
Name:IHEDIKE, JULIET (LCSW)
Entity type:Individual
Prefix:
First Name:JULIET
Middle Name:
Last Name:IHEDIKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JULIET
Other - Middle Name:
Other - Last Name:IFEOBU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:110 EVANS MILL DR STE 305
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-1623
Mailing Address - Country:US
Mailing Address - Phone:678-348-6390
Mailing Address - Fax:678-550-6380
Practice Address - Street 1:110 EVANS MILL DR STE 305
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-1623
Practice Address - Country:US
Practice Address - Phone:678-348-6390
Practice Address - Fax:678-550-6380
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2022-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0074631041C0700X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No172V00000XOther Service ProvidersCommunity Health Worker