Provider Demographics
NPI:1083687412
Name:JEAN, PAULA JOAN (PHD)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:JOAN
Last Name:JEAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 VILLAGE POND LN APT 1406
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-3496
Mailing Address - Country:US
Mailing Address - Phone:804-318-5211
Mailing Address - Fax:804-369-9709
Practice Address - Street 1:1441 VILLAGE POND LN APT 1406
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-3496
Practice Address - Country:US
Practice Address - Phone:804-318-5211
Practice Address - Fax:804-369-9709
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA08100001202103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007702949Medicaid