Basic Information
Provider Information | |||||||||
NPI: | 1730466327 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NEWCOMB | ||||||||
FirstName: | JULIE | ||||||||
MiddleName: | SCHACHERER | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | L.C.S.W | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | NEWCOMB | ||||||||
OtherFirstName: | JULIE | ||||||||
OtherMiddleName: | ANN | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | L.C.S.W. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1401 APPLEWOOD DR | ||||||||
Address2: |   | ||||||||
City: | DALTON | ||||||||
State: | GA | ||||||||
PostalCode: | 307202699 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7062705008 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 4024 CENTRAL AVE | ||||||||
Address2: |   | ||||||||
City: | ST PETERSBURG | ||||||||
State: | FL | ||||||||
PostalCode: | 33711 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7273277656 | ||||||||
FaxNumber: | 7273222110 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/09/2011 | ||||||||
LastUpdateDate: | 07/25/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CSW004539 | GA | N |   | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | SW15394 | FL | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.