Provider Demographics
NPI:1083266373
Name:STANIS, JOSEPH MICHAEL (LMFT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:STANIS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 BRAKE RD
Mailing Address - Street 2:
Mailing Address - City:ELLISTON
Mailing Address - State:VA
Mailing Address - Zip Code:24087-4425
Mailing Address - Country:US
Mailing Address - Phone:860-539-8706
Mailing Address - Fax:540-404-4531
Practice Address - Street 1:503 BRAKE RD
Practice Address - Street 2:
Practice Address - City:ELLISTON
Practice Address - State:VA
Practice Address - Zip Code:24087-4425
Practice Address - Country:US
Practice Address - Phone:860-539-8706
Practice Address - Fax:540-404-4531
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001550106H00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)