Healthcare Provider Details

I. General information

NPI: 1124877410
Provider Name (Legal Business Name): JOSEPH WRISTON LPC, LSATP, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1097 OLD DOMINION CT
MONETA VA
24121-5271
US

IV. Provider business mailing address

1097 OLD DOMINION CT
MONETA VA
24121-5271
US

V. Phone/Fax

Practice location:
  • Phone: 434-426-7731
  • Fax:
Mailing address:
  • Phone: 434-426-7731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701011934
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: