Provider Demographics
NPI:1982110029
Name:GRIESHEIMER, JULLIAN (LICDC)
Entity Type:Individual
Prefix:
First Name:JULLIAN
Middle Name:
Last Name:GRIESHEIMER
Suffix:
Gender:F
Credentials:LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-1643
Mailing Address - Country:US
Mailing Address - Phone:937-642-9555
Mailing Address - Fax:
Practice Address - Street 1:729 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-1643
Practice Address - Country:US
Practice Address - Phone:937-642-9555
Practice Address - Fax:937-738-7326
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.21030111041C0700X
OHLICDC.161547101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)