1568825198 NPI number — MRS. JULIA ANTHONY ROSE MA, LPCA, MBCC

Table of content: MRS. JULIA ANTHONY ROSE MA, LPCA, MBCC (NPI 1568825198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568825198 NPI number — MRS. JULIA ANTHONY ROSE MA, LPCA, MBCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSE
Provider First Name:
JULIA
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPCA, MBCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANTHONY
Provider Other First Name:
JULIA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, LPCA, MBCC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568825198
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
709 NORTHEAST DRIVE
Provider Second Line Business Mailing Address:
SUITE #22
Provider Business Mailing Address City Name:
DAVIDSON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-912-4095
Provider Business Mailing Address Fax Number:
704-943-0512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
709 NORTHEAST DRIVE
Provider Second Line Business Practice Location Address:
SUITE #22
Provider Business Practice Location Address City Name:
DAVIDSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-912-4095
Provider Business Practice Location Address Fax Number:
704-943-0512
Provider Enumeration Date:
03/31/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  A12204 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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