Provider Demographics
NPI:1225194012
Name:WARREN, JULIE (LPC, LCAS, RN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:LPC, LCAS, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 SPRUCE STREET
Mailing Address - Street 2:PO BOX 56
Mailing Address - City:WOODLAND
Mailing Address - State:NC
Mailing Address - Zip Code:27897
Mailing Address - Country:US
Mailing Address - Phone:252-578-4455
Mailing Address - Fax:
Practice Address - Street 1:413 SPRUCE STREET
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:NC
Practice Address - Zip Code:27897
Practice Address - Country:US
Practice Address - Phone:252-578-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5359101YM0800X
NC1498101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103361Medicaid