Provider Demographics
NPI:1295031912
Name:LACUBBERT, JULIE MARIE (PHD)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:MARIE
Last Name:LACUBBERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:MARIE LAMBERT
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS
Mailing Address - Street 1:1653 SHADY PINE ROAD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414
Mailing Address - Country:US
Mailing Address - Phone:803-960-1267
Mailing Address - Fax:843-760-1153
Practice Address - Street 1:1653 SHADY PINE ROAD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414
Practice Address - Country:US
Practice Address - Phone:803-960-1267
Practice Address - Fax:843-760-1153
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4517106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist