Provider Demographics
NPI:1124877410
Name:WRISTON, JOSEPH (LPC, NCC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:WRISTON
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1097 OLD DOMINION CT
Mailing Address - Street 2:
Mailing Address - City:MONETA
Mailing Address - State:VA
Mailing Address - Zip Code:24121-5271
Mailing Address - Country:US
Mailing Address - Phone:434-426-7731
Mailing Address - Fax:
Practice Address - Street 1:119 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-2034
Practice Address - Country:US
Practice Address - Phone:540-586-7750
Practice Address - Fax:540-586-7785
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-17
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011934101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30018017780001Medicaid