Provider Demographics
NPI:1114519303
Name:LIGHT, JULIA MARIE (CDCA)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:MARIE
Last Name:LIGHT
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:MRS
Other - First Name:JULIA
Other - Middle Name:MARIE
Other - Last Name:LIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CDCA
Mailing Address - Street 1:80 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RITTMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44270-1443
Mailing Address - Country:US
Mailing Address - Phone:330-760-9315
Mailing Address - Fax:
Practice Address - Street 1:104 SPINK ST
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-3652
Practice Address - Country:US
Practice Address - Phone:330-264-8498
Practice Address - Fax:330-264-3777
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.175907101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health