Healthcare Provider Details

I. General information

NPI: 1114389475
Provider Name (Legal Business Name): YESENIA C VILLALTA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20098 ASHBROOK PL STE 255
ASHBURN VA
20147-3394
US

IV. Provider business mailing address

20098 ASHBROOK PL STE 255
ASHBURN VA
20147-3394
US

V. Phone/Fax

Practice location:
  • Phone: 804-207-6737
  • Fax: 804-447-3352
Mailing address:
  • Phone: 804-207-6737
  • Fax: 804-447-3352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904009722
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: