Individual
JULIE KWON EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
74 W LONG LAKE RD # 28, BLOOMFIELD HILLS, MI 48304-2769
(773) 963-1523
Mailing address
PO BOX 2125, BIRMINGHAM, MI 48012-2125
(773) 963-1523
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
103TE1100X
Exercise & Sports Psychologist
—
—
103TH0004X
Health Psychologist
—
—
133VN1004X
Pediatric Nutrition Registered Dietitian
—
—
171400000X
Health & Wellness Coach
—
—
171W00000X
Contractor
Primary
M719636
MI
174H00000X
Health Educator
—
—
225700000X
Massage Therapist
—
—
251B00000X
Case Management Agency
—
—
261Q00000X
Clinic/Center
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/31/2017
Last updated
08/11/2021
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