Provider Demographics
NPI:1396242400
Name:JOY, NORA LYNNE (PPS-06007)
Entity type:Individual
Prefix:MRS
First Name:NORA
Middle Name:LYNNE
Last Name:JOY
Suffix:
Gender:F
Credentials:PPS-06007
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8270 WILLOW OAKS CORPORATE DR RM 3059
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4511
Mailing Address - Country:US
Mailing Address - Phone:571-423-4300
Mailing Address - Fax:571-423-4367
Practice Address - Street 1:8270 WILLOW OAKS CORPORATE DR RM 3059
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4511
Practice Address - Country:US
Practice Address - Phone:571-423-4300
Practice Address - Fax:571-423-4367
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPPS-06007591041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6201BARDUMedicaid