Healthcare Provider Details

I. General information

NPI: 1225796386
Provider Name (Legal Business Name): JOSEPH T VANCE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S 5TH ST
RICHMOND VA
23219-3825
US

IV. Provider business mailing address

402 N 29TH ST
RICHMOND VA
23223-7306
US

V. Phone/Fax

Practice location:
  • Phone: 804-819-4100
  • Fax:
Mailing address:
  • Phone: 804-357-6467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904012659
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: