Basic Information
Provider Information
NPI: 1184845679
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARKER-HUBBARD
FirstName: JULIE
MiddleName: A.
NamePrefix:  
NameSuffix:  
Credential: LCPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 78 ATLANTIC PL
Address2:  
City: SOUTH PORTLAND
State: ME
PostalCode: 041062316
CountryCode: US
TelephoneNumber: 2078427701
FaxNumber: 2078427773
Practice Location
Address1: 453 US ROUTE 1
Address2:  
City: KITTERY
State: ME
PostalCode: 039045513
CountryCode: US
TelephoneNumber: 2074511750
FaxNumber: 2074394360
Other Information
ProviderEnumerationDate: 05/01/2007
LastUpdateDate: 07/17/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500XCC3940MEN Behavioral Health & Social Service ProvidersCounselorProfessional
101YM0800XCC3940MEY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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