Provider Demographics
NPI:1669492880
Name:BAGBY, JOY B
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:B
Last Name:BAGBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-0248
Mailing Address - Country:US
Mailing Address - Phone:434-392-7049
Mailing Address - Fax:434-392-9221
Practice Address - Street 1:410 THOMAS JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE CH
Practice Address - State:VA
Practice Address - Zip Code:23923
Practice Address - Country:US
Practice Address - Phone:434-542-5187
Practice Address - Fax:434-542-5879
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003665101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health