Provider Demographics
NPI:1366867434
Name:KOEPPEN, JOY E (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JOY
Middle Name:E
Last Name:KOEPPEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10372 DEMOCRACY LN
Mailing Address - Street 2:B
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2522
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10372 DEMOCRACY LN
Practice Address - Street 2:B
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2522
Practice Address - Country:US
Practice Address - Phone:703-591-2551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040049281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical