Provider Demographics
NPI:1043061765
Name:SMALL, JOYCE SUE
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:SUE
Last Name:SMALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 MAPLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46975-5200
Mailing Address - Country:US
Mailing Address - Phone:574-601-9268
Mailing Address - Fax:
Practice Address - Street 1:816 RUDOLPH WAY
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025
Practice Address - Country:US
Practice Address - Phone:812-847-3741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)