Provider Demographics
NPI:1871746958
Name:HEREDIA, JULIA-ALEJANDRA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JULIA-ALEJANDRA
Middle Name:
Last Name:HEREDIA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:A
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1512
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-7512
Mailing Address - Country:US
Mailing Address - Phone:323-719-7910
Mailing Address - Fax:
Practice Address - Street 1:9449 IMPERIAL HWY STE 201
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2814
Practice Address - Country:US
Practice Address - Phone:800-823-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA64986101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health