Provider Demographics
NPI:1700490828
Name:ISMAIL, JULIA NDIDI (LAC/LPC)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:NDIDI
Last Name:ISMAIL
Suffix:
Gender:F
Credentials:LAC/LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 ENGLISH IVY DR
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-5713
Mailing Address - Country:US
Mailing Address - Phone:856-942-4426
Mailing Address - Fax:
Practice Address - Street 1:34 ENGLISH IVY DR
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-5713
Practice Address - Country:US
Practice Address - Phone:856-942-4426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00541100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional