Provider Demographics
NPI:1154795862
Name:ACOSTA, ANDRES II (LCSW)
Entity type:Individual
Prefix:MR
First Name:ANDRES
Middle Name:
Last Name:ACOSTA
Suffix:II
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4480 KING ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1300
Mailing Address - Country:US
Mailing Address - Phone:703-746-3458
Mailing Address - Fax:703-379-3962
Practice Address - Street 1:4480 KING ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1300
Practice Address - Country:US
Practice Address - Phone:703-746-3458
Practice Address - Fax:703-379-3962
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040088881041C0700X
DCLC500802901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical