Provider Demographics
NPI:1891423315
Name:BYRD, JOSIE MARIE
Entity Type:Individual
Prefix:
First Name:JOSIE
Middle Name:MARIE
Last Name:BYRD
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 1:33651 MONROE RD
Mailing Address - Street 2:
Mailing Address - City:NEWSOMS
Mailing Address - State:VA
Mailing Address - Zip Code:23874-2426
Mailing Address - Country:US
Mailing Address - Phone:757-651-1357
Mailing Address - Fax:
Practice Address - Street 1:293 INDEPENDENCE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5461
Practice Address - Country:US
Practice Address - Phone:757-785-3338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-22-227900106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician