Provider Demographics
NPI:1487145736
Name:FLEAGLE, JULIE (LCPC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:FLEAGLE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PUBLIC SQ STE 428
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5528
Mailing Address - Country:US
Mailing Address - Phone:410-322-5074
Mailing Address - Fax:
Practice Address - Street 1:5 PUBLIC SQ STE 428
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5528
Practice Address - Country:US
Practice Address - Phone:410-322-5074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8274101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor