Provider Demographics
NPI:1528098472
Name:PATERSON, JULIE D (LCSW,LMFT)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:D
Last Name:PATERSON
Suffix:
Gender:F
Credentials:LCSW,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 LINDEN CT
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-2937
Mailing Address - Country:US
Mailing Address - Phone:601-261-9614
Mailing Address - Fax:
Practice Address - Street 1:1003 WEST PINE STREET
Practice Address - Street 2:PERSONAL GROWTH CENTER OF SOUTH MS
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401
Practice Address - Country:US
Practice Address - Phone:601-584-9540
Practice Address - Fax:601-584-9510
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC28371041C0700X
MST0130106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00114796Medicaid