Provider Demographics
NPI:1790802478
Name:360 PYSCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:360 PYSCHOLOGICAL SERVICES
Other - Org Name:THOMAS X JOSEPH
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:X
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:540-702-8573
Mailing Address - Street 1:1133 HEATHERSTONE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-4828
Mailing Address - Country:US
Mailing Address - Phone:540-702-8573
Mailing Address - Fax:
Practice Address - Street 1:1133 HEATHERSTONE DR STE 102
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-4828
Practice Address - Country:US
Practice Address - Phone:540-702-8573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002447103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10126Medicare PIN