Provider Demographics
NPI:1548019474
Name:OUELLETTE, JULIA ALEXANDRA (LCPC-C)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ALEXANDRA
Last Name:OUELLETTE
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 BOYDS CORNER RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03908-2011
Mailing Address - Country:US
Mailing Address - Phone:207-608-9896
Mailing Address - Fax:
Practice Address - Street 1:551 ALFRED ST
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9474
Practice Address - Country:US
Practice Address - Phone:207-608-9896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL7440101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health