Provider Demographics
NPI:1902160005
Name:MOCK, JOY STANDRIDGE (LPC)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:STANDRIDGE
Last Name:MOCK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 PEACHCREST DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-2873
Mailing Address - Country:US
Mailing Address - Phone:678-313-4493
Mailing Address - Fax:678-207-2904
Practice Address - Street 1:243 S CULVER ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4805
Practice Address - Country:US
Practice Address - Phone:678-313-4493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006600101YM0800X
GALPC006600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health