Provider Demographics
NPI:1538893391
Name:SOLOMON, JOY TRACEY (LPA)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:TRACEY
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BARDEN ST
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-5553
Mailing Address - Country:US
Mailing Address - Phone:336-583-8364
Mailing Address - Fax:
Practice Address - Street 1:18 BARDEN ST
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-5553
Practice Address - Country:US
Practice Address - Phone:336-583-8364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1969103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral