Provider Demographics
NPI:1265906069
Name:POLK, JOEL DELAYNE (LMHC)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:DELAYNE
Last Name:POLK
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 S OAK AVE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-4345
Mailing Address - Country:US
Mailing Address - Phone:407-760-8054
Mailing Address - Fax:
Practice Address - Street 1:2500 MAITLAND CENTER PKWY
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7224
Practice Address - Country:US
Practice Address - Phone:407-760-8054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16189101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty