Provider Demographics
NPI:1457699662
Name:EDMONDS, DOTTIE JOYNER (MED/ CAGS)
Entity type:Individual
Prefix:MRS
First Name:DOTTIE
Middle Name:JOYNER
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:MED/ CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 BAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-3702
Mailing Address - Country:US
Mailing Address - Phone:757-289-1637
Mailing Address - Fax:
Practice Address - Street 1:2830 BAYNE AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-3702
Practice Address - Country:US
Practice Address - Phone:757-289-1637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPGP-0610306101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAS435931OtherDOTTIE'S DEVELOPMENTAL CHILDCARE,LLC
VA912601OtherDOTTIE'S DEVELOPMENTAL CHILDCARE,LLC