Provider Demographics
NPI:1619120144
Name:ALLISON, JULIE HARGETTE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:HARGETTE
Last Name:ALLISON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:LYNN
Other - Last Name:HARGETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:500 OLD LYNCHBURG RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-6500
Mailing Address - Country:US
Mailing Address - Phone:434-972-1800
Mailing Address - Fax:434-984-1297
Practice Address - Street 1:500 OLD LYNCHBURG RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-6500
Practice Address - Country:US
Practice Address - Phone:434-972-1800
Practice Address - Fax:434-984-1297
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040058531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945018Medicaid