Provider Demographics
NPI:1194568204
Name:JOYNER, RACQUEL RENEE
Entity type:Individual
Prefix:
First Name:RACQUEL
Middle Name:RENEE
Last Name:JOYNER
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 1:575 LYNNHAVEN PKWY STE 305
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7350
Mailing Address - Country:US
Mailing Address - Phone:948-212-3289
Mailing Address - Fax:
Practice Address - Street 1:575 LYNNHAVEN PKWY STE 305
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7350
Practice Address - Country:US
Practice Address - Phone:948-212-3289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704015153101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty