Provider Demographics
NPI:1831527951
Name:MANDES, JULIA BALLANCE (LAC)
Entity type:Individual
Prefix:MS
First Name:JULIA
Middle Name:BALLANCE
Last Name:MANDES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11714 WINTERWAY LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-2133
Mailing Address - Country:US
Mailing Address - Phone:703-674-9230
Mailing Address - Fax:
Practice Address - Street 1:7130 MINSTREL WAY
Practice Address - Street 2:SUITE 160
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5201
Practice Address - Country:US
Practice Address - Phone:703-674-9230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02110171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist