Provider Demographics
NPI:1942414008
Name:HUNT, JULIA HARRIS (LCSW, BCD)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:HARRIS
Last Name:HUNT
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:HARRIS
Other - Last Name:VANOVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:107 MULRY DR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2398
Mailing Address - Country:US
Mailing Address - Phone:912-247-5000
Mailing Address - Fax:
Practice Address - Street 1:107 MULRY DR
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2398
Practice Address - Country:US
Practice Address - Phone:912-247-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040064871041C0700X
FLSW165561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1942414008Medicaid
VA11692090OtherCAQH
FLEINOtherEIN FOR PRIVATE PRACTICE
VA1942414008Medicaid