Provider Demographics
NPI:1619950235
Name:FORD, JOSEPH ALLEN (LCSW)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ALLEN
Last Name:FORD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 SWORD CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-8117
Mailing Address - Country:US
Mailing Address - Phone:757-479-2314
Mailing Address - Fax:757-622-8585
Practice Address - Street 1:2412 E VIRGINIA BEACH BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-3628
Practice Address - Country:US
Practice Address - Phone:757-622-7474
Practice Address - Fax:757-622-8585
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040024221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL195633OtherCOMPSYCH
VA11412343OtherCAQH
VA088479OtherANTHEM BC/BS
VA088479OtherANTHEM BC/BS