Provider Demographics
NPI:1124484829
Name:CHARBONEAU, JULIA (MSW, LSWAIC, CDP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:CHARBONEAU
Suffix:
Gender:F
Credentials:MSW, LSWAIC, CDP
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:SACHS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17018 15TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-5126
Mailing Address - Country:US
Mailing Address - Phone:206-372-7136
Mailing Address - Fax:
Practice Address - Street 1:17018 15TH AVE NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-5126
Practice Address - Country:US
Practice Address - Phone:206-372-7136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60569991101YA0400X
WASC605439411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical