Provider Demographics
NPI:1902109473
Name:JULIAN, CONNIE DALE (CADDE)
Entity Type:Individual
Prefix:MISS
First Name:CONNIE
Middle Name:DALE
Last Name:JULIAN
Suffix:
Gender:F
Credentials:CADDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8604 LANKERSHIM BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-3140
Mailing Address - Country:US
Mailing Address - Phone:818-768-1600
Mailing Address - Fax:
Practice Address - Street 1:8604 LANKERSHIM BLVD
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-3140
Practice Address - Country:US
Practice Address - Phone:818-768-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)