Provider Demographics
NPI:1659447407
Name:JOINVILLE, JUDITH BLACKBIRD (LMFT)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:BLACKBIRD
Last Name:JOINVILLE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 JAMES RD
Mailing Address - Street 2:
Mailing Address - City:AMERICAN CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94503-1123
Mailing Address - Country:US
Mailing Address - Phone:707-775-1281
Mailing Address - Fax:
Practice Address - Street 1:744 EMPIRE ST
Practice Address - Street 2:SUITE 140
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5510
Practice Address - Country:US
Practice Address - Phone:707-775-1281
Practice Address - Fax:949-862-8025
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT31799106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist