Provider Demographics
NPI:1407565112
Name:EBERSOLE, JULIE E (MA, QMHP-C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:E
Last Name:EBERSOLE
Suffix:
Gender:F
Credentials:MA, QMHP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 QUAIL HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22664-4027
Mailing Address - Country:US
Mailing Address - Phone:540-325-7234
Mailing Address - Fax:
Practice Address - Street 1:2008 BREMO RD STE 111
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2443
Practice Address - Country:US
Practice Address - Phone:804-404-6105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0733006794101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA351348766012Medicaid