Provider Demographics
NPI:1881729572
Name:GREENE, JULIE ANNE (SUDP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:GREENE
Suffix:
Gender:F
Credentials:SUDP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANNE
Other - Last Name:BORBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CATC 1
Mailing Address - Street 1:PO BOX 2429
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-8486
Mailing Address - Country:US
Mailing Address - Phone:360-575-3314
Mailing Address - Fax:360-575-3314
Practice Address - Street 1:15455 65TH AVE S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2534
Practice Address - Country:US
Practice Address - Phone:206-721-5170
Practice Address - Fax:206-575-1950
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61416256101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)