Provider Demographics
NPI:1629111885
Name:EVERETT, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:EVERETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 S 8TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-3744
Mailing Address - Country:US
Mailing Address - Phone:904-491-2001
Mailing Address - Fax:904-491-2017
Practice Address - Street 1:910 S 8TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3744
Practice Address - Country:US
Practice Address - Phone:904-491-2001
Practice Address - Fax:904-491-2017
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool