Provider Demographics
NPI:1386126795
Name:JEROME, JULIA ANN (LPC)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ANN
Last Name:JEROME
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:JEROME
Other - Last Name:TIPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:211 THORNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0296
Mailing Address - Country:US
Mailing Address - Phone:912-687-1105
Mailing Address - Fax:
Practice Address - Street 1:140 LANIER DRIVE
Practice Address - Street 2:APT 28
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458
Practice Address - Country:US
Practice Address - Phone:912-549-3784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010358101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional