Provider Demographics
NPI:1760714489
Name:KWANDT, JOANNE (EDD)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:KWANDT
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-4526
Mailing Address - Country:US
Mailing Address - Phone:804-402-1611
Mailing Address - Fax:804-308-1499
Practice Address - Street 1:2012 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4526
Practice Address - Country:US
Practice Address - Phone:804-402-1611
Practice Address - Fax:804-308-1499
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002062101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional