Provider Demographics
NPI:1205936804
Name:JUNG, YUDIT (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:YUDIT
Middle Name:
Last Name:JUNG
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2306
Mailing Address - Country:US
Mailing Address - Phone:478-477-9334
Mailing Address - Fax:478-477-9334
Practice Address - Street 1:168 MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2306
Practice Address - Country:US
Practice Address - Phone:478-477-9334
Practice Address - Fax:478-477-9334
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0028291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00902426AMedicaid
GA00902426AMedicaid