Provider Demographics
NPI:1063037265
Name:COFFEY, JULIE E (LCMHC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:E
Last Name:COFFEY
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 OLD STONEHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:VT
Mailing Address - Zip Code:05491-8405
Mailing Address - Country:US
Mailing Address - Phone:901-619-6420
Mailing Address - Fax:
Practice Address - Street 1:359 DORSET ST
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6580
Practice Address - Country:US
Practice Address - Phone:802-865-3450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134236101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health