Provider Demographics
NPI:1457853327
Name:LOOMIS, JOSIE LYNN (MS, EDS)
Entity Type:Individual
Prefix:MRS
First Name:JOSIE
Middle Name:LYNN
Last Name:LOOMIS
Suffix:
Gender:F
Credentials:MS, EDS
Other - Prefix:MISS
Other - First Name:JOSIE
Other - Middle Name:LYNN
Other - Last Name:OWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:750 IMPERIAL ST
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-5309
Mailing Address - Country:US
Mailing Address - Phone:540-382-5114
Mailing Address - Fax:540-394-4448
Practice Address - Street 1:750 IMPERIAL ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-5309
Practice Address - Country:US
Practice Address - Phone:540-382-5114
Practice Address - Fax:540-394-4448
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0813000270103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool