Healthcare Provider Details

I. General information

NPI: 1629558564
Provider Name (Legal Business Name): ANDREA D JOSEPHS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2816 CHRISTOPHER FARMS DR
VIRGINIA BCH VA
23453-6681
US

IV. Provider business mailing address

2816 CHRISTOPHER FARMS DR
VIRGINIA BCH VA
23453-6681
US

V. Phone/Fax

Practice location:
  • Phone: 757-536-3257
  • Fax: 757-430-1869
Mailing address:
  • Phone: 757-536-3257
  • Fax: 757-430-1869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: