Provider Demographics
NPI:1568825198
Name:ROSE, JULIA ANTHONY (MA, LPCA, MBCC)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:ANTHONY
Last Name:ROSE
Suffix:
Gender:F
Credentials:MA, LPCA, MBCC
Other - Prefix:MS
Other - First Name:JULIA
Other - Middle Name:MARIE
Other - Last Name:ANTHONY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPCA, MBCC
Mailing Address - Street 1:709 NORTHEAST DRIVE
Mailing Address - Street 2:SUITE #22
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036
Mailing Address - Country:US
Mailing Address - Phone:704-912-4095
Mailing Address - Fax:704-943-0512
Practice Address - Street 1:709 NORTHEAST DRIVE
Practice Address - Street 2:SUITE #22
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036
Practice Address - Country:US
Practice Address - Phone:704-912-4095
Practice Address - Fax:704-943-0512
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12204101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health