Healthcare Provider Details

I. General information

NPI: 1740058700
Provider Name (Legal Business Name): JOELLE DIMICELE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20500 WARRIORS WAY
MILFORD VA
22514-2867
US

IV. Provider business mailing address

16611 ACCOLON CT
DUMFRIES VA
22025-3130
US

V. Phone/Fax

Practice location:
  • Phone: 404-275-3664
  • Fax:
Mailing address:
  • Phone: 404-275-3664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904015955
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: