Provider Demographics
NPI:1952065849
Name:RUND, JULIE MARIE (LPC, ATR)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:RUND
Suffix:
Gender:F
Credentials:LPC, ATR
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:MARIE
Other - Last Name:BAZAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14132 AUTUMN CIR
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-3849
Mailing Address - Country:US
Mailing Address - Phone:314-276-9741
Mailing Address - Fax:
Practice Address - Street 1:14132 AUTUMN CIR
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-3849
Practice Address - Country:US
Practice Address - Phone:314-276-9741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
19-186221700000X
VA0701010626101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist