Provider Demographics
NPI:1629273958
Name:GROHSE, JULIA LEE (PA)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:LEE
Last Name:GROHSE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 HILLSBOROUGH ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-1727
Mailing Address - Country:US
Mailing Address - Phone:919-821-0790
Mailing Address - Fax:919-861-8961
Practice Address - Street 1:401 HILLSBOROUGH ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1727
Practice Address - Country:US
Practice Address - Phone:919-821-0790
Practice Address - Fax:919-861-8961
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0438101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107216Medicaid