Healthcare Provider Details

I. General information

NPI: 1477726750
Provider Name (Legal Business Name): JULIE KENT MOONEY LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 CHESTWOOD DR
HUBERT NC
28539-0019
US

IV. Provider business mailing address

204 CHESTWOOD DR
HUBERT NC
28539-0019
US

V. Phone/Fax

Practice location:
  • Phone: 540-493-8817
  • Fax:
Mailing address:
  • Phone: 540-493-8817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC017611
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: