Provider Demographics
NPI:1306079132
Name:HULON, RICHARD WAYNE (MDIV)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:WAYNE
Last Name:HULON
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 JOHNS CREEK CT
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1224
Mailing Address - Country:US
Mailing Address - Phone:770-540-0366
Mailing Address - Fax:770-886-2423
Practice Address - Street 1:3905 JOHNS CREEK CT
Practice Address - Street 2:SUITE 240
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1224
Practice Address - Country:US
Practice Address - Phone:770-540-0366
Practice Address - Fax:770-886-2423
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001752101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor