Healthcare Provider Details

I. General information

NPI: 1629459870
Provider Name (Legal Business Name): BILLIE HULLUM CADCII, BCBC, BCACLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2015
Last Update Date: 06/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 HUDSON TRCE SUITE 111
AUGUSTA GA
30907-2010
US

IV. Provider business mailing address

207 HUDSON TRCE SUITE 111
AUGUSTA GA
30907-2010
US

V. Phone/Fax

Practice location:
  • Phone: 706-799-7743
  • Fax: 706-262-2899
Mailing address:
  • Phone: 706-799-7743
  • Fax: 706-262-2899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0612
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: