Provider Demographics
NPI:1407261431
Name:GLEIM, JULIE KRISTEN (LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:KRISTEN
Last Name:GLEIM
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:KRISTEN
Other - Last Name:MANNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:817 GRAMERCY ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-5904
Mailing Address - Country:US
Mailing Address - Phone:919-635-4758
Mailing Address - Fax:919-891-1615
Practice Address - Street 1:823 W 5TH ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-2544
Practice Address - Country:US
Practice Address - Phone:919-635-4758
Practice Address - Fax:919-891-1615
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-28
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10716101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1407261431Medicaid
NC19FMOOtherBCBS
NC12711595OtherCAQH