Provider Demographics
NPI:1568441624
Name:SOUK, JOYCE H (MSW)
Entity Type:Individual
Prefix:MS
First Name:JOYCE
Middle Name:H
Last Name:SOUK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10204 HUNT COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-1818
Mailing Address - Country:US
Mailing Address - Phone:703-281-6591
Mailing Address - Fax:703-281-1302
Practice Address - Street 1:12050 S LAKES DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1220
Practice Address - Country:US
Practice Address - Phone:703-860-5655
Practice Address - Fax:703-281-1302
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040012351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11527455OtherCAQH UNIVERSAL CREDENTIAL
VAA309OtherCARE FIRST BCBS PROV. ID
VA010195306Medicaid
VA5851262OtherAETNA PROVIDER NUMBER
VA441854OtherANTHEM INS. PROVIDER NUMB
VA010195306Medicaid