1972028389 NPI number — CENTER OF JOY PSYCHOLOGICAL SERVICES, PLLC

Table of content: (NPI 1972028389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972028389 NPI number — CENTER OF JOY PSYCHOLOGICAL SERVICES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER OF JOY PSYCHOLOGICAL SERVICES, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972028389
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4410 CANVASBACK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
N DINWIDDIE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23803-6831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11923 CENTRE ST STE A-1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTER
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23831-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-894-7295
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/07/2017

Additional Information

Authorized Official

Authorized Official Last Name:
TERRY
Authorized Official First Name:
JOY
Authorized Official Middle Name:
DRUMGOLD
Authorized Official Title or Position:
PSYCHOLOGIST/CEO
Authorized Official Telephone Number:
804-894-7295

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 601150188 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".




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