Provider Demographics
NPI:1508572033
Name:DURALL, JUDITH CARLA (MA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:CARLA
Last Name:DURALL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8936
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-0936
Mailing Address - Country:US
Mailing Address - Phone:423-791-1534
Mailing Address - Fax:
Practice Address - Street 1:123 BOB JOBE RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37615-2142
Practice Address - Country:US
Practice Address - Phone:423-791-1534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPE1622.101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional