Provider Demographics
NPI:1750556874
Name:WEAVER, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 POSTAL SERVICE LOOP # 1025
Mailing Address - Street 2:BLDG 1108, 2ND FLOOR
Mailing Address - City:JBER
Mailing Address - State:AK
Mailing Address - Zip Code:99505-5001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5312 JAGUAR DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-1827
Practice Address - Country:US
Practice Address - Phone:505-820-0262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-080111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical