Provider Demographics
NPI:1598005456
Name:ROY, JOSEPH C (LMHC, CAP,ICADC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:C
Last Name:ROY
Suffix:
Gender:M
Credentials:LMHC, CAP,ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 11TH ST
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-1474
Mailing Address - Country:US
Mailing Address - Phone:904-347-4162
Mailing Address - Fax:
Practice Address - Street 1:409 11TH ST
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-1474
Practice Address - Country:US
Practice Address - Phone:904-347-4162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3138101YA0400X
FLMH11654101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)