Provider Demographics
NPI:1730647686
Name:JULES, AUTUMN ELIZABETH
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:ELIZABETH
Last Name:JULES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4108 PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-2259
Mailing Address - Country:US
Mailing Address - Phone:603-397-7658
Mailing Address - Fax:
Practice Address - Street 1:4108 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-2259
Practice Address - Country:US
Practice Address - Phone:603-397-7658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health