Provider Demographics
NPI:1609129964
Name:MASSEY, JOAN EILEEN (LAC/DOM)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:EILEEN
Last Name:MASSEY
Suffix:
Gender:F
Credentials:LAC/DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-2821
Mailing Address - Country:US
Mailing Address - Phone:864-406-3800
Mailing Address - Fax:864-406-3802
Practice Address - Street 1:3100 GRANDVIEW DR
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-2821
Practice Address - Country:US
Practice Address - Phone:864-406-3800
Practice Address - Fax:864-406-3802
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC135171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist