Provider Demographics
NPI:1275149684
Name:PAEK, JOANNE M (MS)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:M
Last Name:PAEK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15912 PRIMROSE TARRY DR
Mailing Address - Street 2:
Mailing Address - City:MOSELEY
Mailing Address - State:VA
Mailing Address - Zip Code:23120-2236
Mailing Address - Country:US
Mailing Address - Phone:804-475-4334
Mailing Address - Fax:
Practice Address - Street 1:8720 FOREST HILL AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-2432
Practice Address - Country:US
Practice Address - Phone:804-325-1669
Practice Address - Fax:804-325-1670
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704012041101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health