Healthcare Provider Details

I. General information

NPI: 1538502166
Provider Name (Legal Business Name): RALSTON JOSEPH MIMS PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8348 TRAFORD LN SUITE 102
SPRINGFIELD VA
22152-1663
US

IV. Provider business mailing address

9229 ASHLAND WOODS LN APT. A2
LORTON VA
22079-1837
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-8731
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: