Provider Demographics
NPI:1376063362
Name:WEED, JULIANA (CADC-CAS)
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:
Last Name:WEED
Suffix:
Gender:F
Credentials:CADC-CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54420 AVENIDA JUAREZ
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-3667
Mailing Address - Country:US
Mailing Address - Phone:760-567-5807
Mailing Address - Fax:
Practice Address - Street 1:54420 AVENIDA JUAREZ
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-3667
Practice Address - Country:US
Practice Address - Phone:760-567-5807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC034580415101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)