Healthcare Provider Details

I. General information

NPI: 1790850899
Provider Name (Legal Business Name): JULIE A NIVEN SOCIAL WORKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 24TH ST DEPT. OF BEHAVIORAL HEALTH
FORT LEE VA
23801-1716
US

IV. Provider business mailing address

700 24TH ST DEPT. OF BEHAVIORAL HEALTH
FORT LEE VA
23801-1716
US

V. Phone/Fax

Practice location:
  • Phone: 804-765-3378
  • Fax:
Mailing address:
  • Phone: 804-765-3378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1596 C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: