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General NPI Number Information
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NPI Number | 1154795862
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Entity Type | Individual
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Provider Name | ANDRES ACOSTA II LCSW
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Gender | Male
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Dates
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Enumeration Date | 11/18/2015
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Last Update Date | 11/18/2015
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Provider Practice Location Address
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Address Line | 4480 KING ST 5TH FLOOR
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City | ALEXANDRIA
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State | VA
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Zip | 22302-1300
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Country | US
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Telephone | 703-746-3458
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Fax | 703-379-3962
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Provider Business Mailing Address
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Address Line | 4480 KING ST 5TH FLOOR
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City | ALEXANDRIA
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State | VA
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Zip | 22302-1300
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Country | US
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Telephone | 703-746-3458
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Fax | 703-379-3962
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904008888
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC50080290
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License Number State | DC
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