Healthcare Provider Details

I. General information

NPI: 1871746958
Provider Name (Legal Business Name): JULIA-ALEJANDRA HEREDIA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIA A. DIAZ

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 12/10/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9449 IMPERIAL HWY STE 201
DOWNEY CA
90242-2814
US

IV. Provider business mailing address

PO BOX 1512
MONTEBELLO CA
90640-7512
US

V. Phone/Fax

Practice location:
  • Phone: 800-823-4040
  • Fax:
Mailing address:
  • Phone: 323-719-7910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number64986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: