Provider Demographics
NPI:1356555601
Name:CHILDS, JULIE RENEE (PHD,CADC,CGAC CAP)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:RENEE
Last Name:CHILDS
Suffix:
Gender:F
Credentials:PHD,CADC,CGAC CAP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:RENEE
Other - Last Name:ROBERTSON OR BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:533 N NOVA RD STE 114
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4421
Mailing Address - Country:US
Mailing Address - Phone:386-227-7014
Mailing Address - Fax:
Practice Address - Street 1:533 N NOVA RD STE 114
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4421
Practice Address - Country:US
Practice Address - Phone:386-227-7014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4417101YA0400X
FL0018101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor