Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ||
N | 225C00000X | Rehabilitation Counselor |
NPI | 1174030613 |
---|---|
Provider Name | Julia Eagles |
First Address | Ukiah, CA 95482-1449 |
Second Address | Fort Bragg, CA 95437-5107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2018 |
Last Update Date | 05/01/2018 |