Provider Demographics
NPI:1720691157
Name:MONTGOMERY, JULIE A (MA, NCC, LPC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5242 PORT ROYAL RD #1633
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151
Mailing Address - Country:US
Mailing Address - Phone:440-462-2188
Mailing Address - Fax:
Practice Address - Street 1:7810 BAXTER CT
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-5102
Practice Address - Country:US
Practice Address - Phone:404-462-2188
Practice Address - Fax:571-533-1388
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701009848101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional