Provider Demographics
NPI:1578068904
Name:EASLEY, JOSEPH (MS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:EASLEY
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 AMERIS AVE
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-7338
Mailing Address - Country:US
Mailing Address - Phone:334-791-0022
Mailing Address - Fax:
Practice Address - Street 1:309 AMERIS AVE
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-7338
Practice Address - Country:US
Practice Address - Phone:334-791-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health