Healthcare Provider Details

I. General information

NPI: 1083687412
Provider Name (Legal Business Name): PAULA JOAN JEAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 VILLAGE POND LN APT 1406
RICHMOND VA
23227-3496
US

IV. Provider business mailing address

1441 VILLAGE POND LN APT 1406
RICHMOND VA
23227-3496
US

V. Phone/Fax

Practice location:
  • Phone: 804-318-5211
  • Fax: 804-369-9709
Mailing address:
  • Phone: 804-318-5211
  • Fax: 804-369-9709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number08100001202
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: