Provider Demographics
NPI:1316142912
Name:MOREIRA BABALOLA, JULIE ANNE (LSW LCSWA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:MOREIRA BABALOLA
Suffix:
Gender:F
Credentials:LSW LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 443
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28106-0443
Mailing Address - Country:US
Mailing Address - Phone:704-293-2694
Mailing Address - Fax:704-803-8372
Practice Address - Street 1:1515 MOCKINGBIRD LN # 420
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3236
Practice Address - Country:US
Practice Address - Phone:704-293-2694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW125282104100000X
NCP0188151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker