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General NPI Number Information
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NPI Number | 1962768572
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Entity Type | Individual
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Provider Name | JULIET IHEDIKE LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/09/2012
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Last Update Date | 08/28/2022
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Provider Practice Location Address
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Address Line | 110 EVANS MILL DR STE 305
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City | DALLAS
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State | GA
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Zip | 30157-1623
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Country | US
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Telephone | 678-348-6390
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Fax | 678-550-6380
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Provider Business Mailing Address
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Address Line | 110 EVANS MILL DR STE 305
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City | DALLAS
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State | GA
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Zip | 30157-1623
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Country | US
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Telephone | 678-348-6390
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Fax | 678-550-6380
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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 | CSW007463
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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