Provider Demographics
NPI:1720674286
Name:DOERNER, JULIE ANNETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNETTE
Last Name:DOERNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-0609
Mailing Address - Country:US
Mailing Address - Phone:616-226-6138
Mailing Address - Fax:
Practice Address - Street 1:822 G ST STE C
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6223
Practice Address - Country:US
Practice Address - Phone:616-226-6138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS151601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical