Healthcare Provider Details

I. General information

NPI: 1306693106
Provider Name (Legal Business Name): EMMA YACKSO LCSW
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 W 47TH ST
RICHMOND VA
23225-4649
US

IV. Provider business mailing address

1004 W 47TH ST
RICHMOND VA
23225-4649
US

V. Phone/Fax

Practice location:
  • Phone: 434-996-8166
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904012642
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: