Individual
JULIE SHORTRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPC
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC003547
GA
1041C0700X
Clinical Social Worker
S-0008535
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201559520
TID
GA
01
—
201559520
TID
—
Enumeration date
06/16/2005
Last updated
09/24/2018
Update your record
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