Healthcare Provider Details

I. General information

NPI: 1598650590
Provider Name (Legal Business Name): NATASHA RACHEL DAVALT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 ROUTE 70 E STE A-101
MARLTON NJ
08053-2341
US

IV. Provider business mailing address

765 ROUTE 70 E STE A-101
MARLTON NJ
08053-2341
US

V. Phone/Fax

Practice location:
  • Phone: 717-571-0065
  • Fax: 717-571-0065
Mailing address:
  • Phone: 717-571-0065
  • Fax: 717-571-0065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00375300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37GA00044700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: