Provider Demographics
NPI:1235156142
Name:CULLIGAN, JULIA WALLIN (PHD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:WALLIN
Last Name:CULLIGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:ALICE
Other - Last Name:WALLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1244 CATAWBA ST
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4506
Mailing Address - Country:US
Mailing Address - Phone:423-276-7300
Mailing Address - Fax:
Practice Address - Street 1:1244 CATAWBA ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4506
Practice Address - Country:US
Practice Address - Phone:423-857-5571
Practice Address - Fax:423-857-5237
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002722103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling