Provider Demographics
NPI:1871609602
Name:JOLLA, J. GRAHAM (LCSW)
Entity type:Individual
Prefix:MRS
First Name:J.
Middle Name:GRAHAM
Last Name:JOLLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10950JEFFERSON HWY. APT. W-14
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70123
Mailing Address - Country:US
Mailing Address - Phone:504-737-2206
Mailing Address - Fax:
Practice Address - Street 1:1601 PERDIDO ST.
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112
Practice Address - Country:US
Practice Address - Phone:504-585-2907
Practice Address - Fax:504-310-6200
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA55331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical