Provider Demographics
NPI:1417960857
Name:O'BRIEN, JOSEPH F JR (LPC, LSATP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:F
Last Name:O'BRIEN
Suffix:JR
Gender:M
Credentials:LPC, LSATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5361A VIRGINIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1897
Mailing Address - Country:US
Mailing Address - Phone:757-456-2366
Mailing Address - Fax:757-321-6269
Practice Address - Street 1:12829 JEFFERSON AVE STE 101
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-3057
Practice Address - Country:US
Practice Address - Phone:757-875-0060
Practice Address - Fax:757-877-7883
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002875101YP2500X
VA0718000069101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1417960857Medicaid
11526985OtherCAQH