Provider Demographics
NPI:1841980224
Name:HEACOCK, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:HEACOCK
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 1:33 KEYES HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ACWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03607-4703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NH
Practice Address - Zip Code:03773-1429
Practice Address - Country:US
Practice Address - Phone:603-863-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor