Provider Demographics
NPI:1700757267
Name:JOLLY, LAURIE DENISE
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:DENISE
Last Name:JOLLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:882 DEERCREST CIR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4228
Mailing Address - Country:US
Mailing Address - Phone:706-294-6690
Mailing Address - Fax:706-651-1289
Practice Address - Street 1:882 DEERCREST CIR
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-4228
Practice Address - Country:US
Practice Address - Phone:706-294-6690
Practice Address - Fax:706-651-1289
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010647751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty