Provider Demographics
NPI:1649533001
Name:MULLIGAN, JULIE NICOLE (CAC-ADP)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:NICOLE
Last Name:MULLIGAN
Suffix:
Gender:F
Credentials:CAC-ADP
Other - Prefix:MRS
Other - First Name:JULIE
Other - Middle Name:NICOLE
Other - Last Name:BOUGTAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAC-ADP
Mailing Address - Street 1:PO BOX 980
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-0980
Mailing Address - Country:US
Mailing Address - Phone:410-535-3079
Mailing Address - Fax:410-535-2220
Practice Address - Street 1:280 STAFFORD RD
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3582
Practice Address - Country:US
Practice Address - Phone:410-535-3079
Practice Address - Fax:410-535-2220
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MDADT542390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)