Provider Demographics
NPI:1457356214
Name:BROWN, JULIA L (LCSW, LCAC)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW, LCAC
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:LOUISE
Other - Last Name:WEIDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2100 COUNTRY CLUB RD
Mailing Address - Street 2:APT. 406
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6465
Mailing Address - Country:US
Mailing Address - Phone:317-626-2790
Mailing Address - Fax:
Practice Address - Street 1:100 BREWSTER BLVD
Practice Address - Street 2:NAVAL HOSPITAL
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547-2538
Practice Address - Country:US
Practice Address - Phone:910-450-4529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87001292A101YA0400X
IN34004930A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000822119OtherANTHEM BCBS
IN000000822135OtherANTHEM BCBS
IN000000362977OtherANTHEM BCBS