Provider Demographics
NPI:1639430408
Name:ST. JULIEN, TANYA (LPC)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:ST. JULIEN
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 1:505 OBERLIN RD
Mailing Address - Street 2:STE 110
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1327
Mailing Address - Country:US
Mailing Address - Phone:337-255-6529
Mailing Address - Fax:
Practice Address - Street 1:505 OBERLIN RD
Practice Address - Street 2:STE 110
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1327
Practice Address - Country:US
Practice Address - Phone:337-255-6529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9452101YP2500X, 101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC163943408OtherCIGNA
NC1639430408OtherBLUE CROSS BLUE SHEILD
NC9452OtherLICENSED PROFESSIONAL COUNSELOR
NC1639430408Medicaid