Provider Demographics
NPI:1184332298
Name:CHUNG, JULIA
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 CHESTNUT ST STE 2
Mailing Address - Street 2:#1019
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2700
Mailing Address - Country:US
Mailing Address - Phone:267-225-6128
Mailing Address - Fax:
Practice Address - Street 1:1500 CHESTNUT ST STE 2
Practice Address - Street 2:#1019
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2700
Practice Address - Country:US
Practice Address - Phone:267-225-6128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC014928101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional