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General NPI Number Information
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NPI Number | 1538502166
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Entity Type | Individual
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Provider Name | RALSTON JOSEPH MIMS PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 04/12/2013
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Last Update Date | 04/12/2013
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Provider Practice Location Address
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Address Line | 8348 TRAFORD LN SUITE 102
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City | SPRINGFIELD
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State | VA
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Zip | 22152-1663
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Country | US
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Telephone | 703-569-8731
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Fax |
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Provider Business Mailing Address
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Address Line | 9229 ASHLAND WOODS LN APT. A2
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City | LORTON
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State | VA
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Zip | 22079-1837
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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