Healthcare Provider Details

I. General information

NPI: 1861745051
Provider Name (Legal Business Name): JULIE CRAWFORD KECK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3665 WHEELER RD STE 1A
AUGUSTA GA
30909-6596
US

IV. Provider business mailing address

2817 INGLESIDE DR
AUGUSTA GA
30909-3795
US

V. Phone/Fax

Practice location:
  • Phone: 706-250-3902
  • Fax:
Mailing address:
  • Phone: 706-414-6811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH 10152
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC009005
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: