Provider Demographics
NPI:1154862621
Name:JOSEPH, DASHIA JENAE
Entity type:Individual
Prefix:
First Name:DASHIA
Middle Name:JENAE
Last Name:JOSEPH
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 1:110 FORDHAM CIR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-1804
Mailing Address - Country:US
Mailing Address - Phone:707-655-5314
Mailing Address - Fax:
Practice Address - Street 1:110 FORDHAM CIR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-1804
Practice Address - Country:US
Practice Address - Phone:707-655-5314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst