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General NPI Number Information
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NPI Number | 1932330149
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Entity Type | Individual
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Provider Name | JULIUS LASHAME JESSUP PETERSON LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/05/2009
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Last Update Date | 04/17/2018
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Provider Practice Location Address
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Address Line | 209A SWANTON WAY STE 202
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City | DECATUR
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State | GA
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Zip | 30030-3271
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Country | US
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Telephone | 404-626-2976
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Fax |
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Provider Business Mailing Address
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Address Line | 209A SWANTON WAY STE 202
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City | DECATUR
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State | GA
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Zip | 30030-3271
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Country | US
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Telephone | 404-626-2976
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW005018
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License Number State | GA
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