Provider Demographics
NPI:1811744360
Name:JD MATSUNAGA LLC
Entity type:Organization
Organization Name:JD MATSUNAGA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATSUNAGA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:404-644-1162
Mailing Address - Street 1:86 SLEEPY HOLLOW RD # B
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-5281
Mailing Address - Country:US
Mailing Address - Phone:404-644-1162
Mailing Address - Fax:
Practice Address - Street 1:72 PUBLIC SQ N STE B
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1254
Practice Address - Country:US
Practice Address - Phone:404-644-1162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty