Provider Demographics
NPI:1699864371
Name:BALIAN, JOAN SHEILA (EDS)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:SHEILA
Last Name:BALIAN
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 EAST SOUTH STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-5217
Mailing Address - Country:US
Mailing Address - Phone:434-984-3111
Mailing Address - Fax:434-984-3119
Practice Address - Street 1:100 EAST SOUTH STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-5217
Practice Address - Country:US
Practice Address - Phone:434-984-3111
Practice Address - Fax:434-984-3119
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
48357101Y00000X
VA0701003119101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional