Healthcare Provider Details

I. General information

NPI: 1891023669
Provider Name (Legal Business Name): JOI DYSON LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2009
Last Update Date: 12/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 SAINT PAUL ST
BALTIMORE MD
21218-4760
US

IV. Provider business mailing address

6133 MARLORA RD
BALTIMORE MD
21239-1929
US

V. Phone/Fax

Practice location:
  • Phone: 410-558-0032
  • Fax: 410-366-2108
Mailing address:
  • Phone: 410-262-7104
  • Fax: 410-366-2108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14741
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: