Provider Demographics
NPI:1649060476
Name:JUSTILIEN, BERNIE (EDD)
Entity type:Individual
Prefix:DR
First Name:BERNIE
Middle Name:
Last Name:JUSTILIEN
Suffix:
Gender:
Credentials:EDD
Other - Prefix:DR
Other - First Name:BERNIE
Other - Middle Name:JEAN
Other - Last Name:JUSTILIEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD
Mailing Address - Street 1:73 SHINING WATER LN
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-7007
Mailing Address - Country:US
Mailing Address - Phone:305-833-1849
Mailing Address - Fax:
Practice Address - Street 1:1487 2ND ST # C-5
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-4911
Practice Address - Country:US
Practice Address - Phone:305-833-1849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH27642101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health