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NPI Code Detail

MEDICARE: BILLIE HULLUM CADCII, BCBC, BCACLC

MEDICARE: BILLIE HULLUM CADCII, BCBC, BCACLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor0612GA

General Provider Information

NPI Number : 1629459870
Entity Type Code : Individual
Provider Name (Legal Business Name) : BILLIE HULLUM CADCII, BCBC, BCACLC
Provider Business Mailing Address
First Line : 207 HUDSON TRCE
Second Line : SUITE 111
City : AUGUSTA
State : GA
Zip : 30907-2010
Country : US
Telephone Number : 706-799-7743
Fax Number : 706-262-2899
Provider Business Practice Location Address
First Line : 207 HUDSON TRCE
Second Line : SUITE 111
City : AUGUSTA
State : GA
Zip : 30907-2010
Country : US
Telephone Number : 706-799-7743
Fax Number : 706-262-2899
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2015
Last Update Date : 06/13/2015

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