Provider Demographics
NPI:1013151042
Name:BLACK, JULIA MARGARET (MFCC 42256 CALIF)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:MARGARET
Last Name:BLACK
Suffix:
Gender:F
Credentials:MFCC 42256 CALIF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6049 DOUGLAS BLVD.
Mailing Address - Street 2:SUITE 19
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746
Mailing Address - Country:US
Mailing Address - Phone:916-791-2052
Mailing Address - Fax:
Practice Address - Street 1:6049 DOUGLAS BLVD.
Practice Address - Street 2:SUITE 19
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746
Practice Address - Country:US
Practice Address - Phone:916-791-2052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFCC42256106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist