Provider Demographics
NPI:1609937622
Name:ETHRIDGE, JULIE M (LPC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:ETHRIDGE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 KATHY LN SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-1026
Mailing Address - Country:US
Mailing Address - Phone:256-306-4023
Mailing Address - Fax:256-306-4113
Practice Address - Street 1:1615 KATHY LN SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-1026
Practice Address - Country:US
Practice Address - Phone:256-306-4023
Practice Address - Fax:256-306-4113
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL614101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health