Provider Demographics
NPI:1285300095
Name:THEISZMANN, JULIA CORNELIA (LISW-CP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:CORNELIA
Last Name:THEISZMANN
Suffix:
Gender:
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 N ADAIR ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-2005
Mailing Address - Country:US
Mailing Address - Phone:864-720-9037
Mailing Address - Fax:
Practice Address - Street 1:400 S MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2251
Practice Address - Country:US
Practice Address - Phone:864-720-9037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC144951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical