Provider Demographics
NPI:1578784112
Name:JOYCE, CHARLES M (LICSW)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:M
Last Name:JOYCE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E WACHTER AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-7246
Mailing Address - Country:US
Mailing Address - Phone:701-224-9611
Mailing Address - Fax:701-224-9747
Practice Address - Street 1:418 E BROADWAY AVE
Practice Address - Street 2:SUITE 25
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4086
Practice Address - Country:US
Practice Address - Phone:701-224-9611
Practice Address - Fax:701-224-9747
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND6821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19117Medicaid
ND19117Medicaid