1023256104 NPI number — VALERIE DALTON ACOSTA LPC

Table of content: VALERIE DALTON ACOSTA LPC (NPI 1023256104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023256104 NPI number — VALERIE DALTON ACOSTA LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ACOSTA
Provider First Name:
VALERIE
Provider Middle Name:
DALTON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DALTON
Provider Other First Name:
VALERIE
Provider Other Middle Name:
CLAIRE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023256104
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4990 SADLER PLACE
Provider Second Line Business Mailing Address:
#3372
Provider Business Mailing Address City Name:
GLEN ALLEN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23060-3372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-396-2585
Provider Business Mailing Address Fax Number:
804-270-2090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11809 WILLPAGE PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENRICO
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23233-1673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-396-2585
Provider Business Practice Location Address Fax Number:
804-364-5678
Provider Enumeration Date:
01/28/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  0701003869 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11914039 . This is a "CAQH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".