Provider Demographics
NPI:1184443871
Name:MORETT-VIJ, JULIA ROSE
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ROSE
Last Name:MORETT-VIJ
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 1:3185 WILDHORSE DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-7817
Mailing Address - Country:US
Mailing Address - Phone:516-582-3760
Mailing Address - Fax:
Practice Address - Street 1:3185 WILDHORSE DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-7817
Practice Address - Country:US
Practice Address - Phone:516-582-3760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4921106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist