Provider Demographics
NPI:1316342876
Name:BALDASSARO, VIRGINIA ALICE (LPC)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:ALICE
Last Name:BALDASSARO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:ALICE
Other - Last Name:CANFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-S
Mailing Address - Street 1:814 W 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7405
Mailing Address - Country:US
Mailing Address - Phone:985-200-3382
Mailing Address - Fax:
Practice Address - Street 1:814 W 21ST AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7405
Practice Address - Country:US
Practice Address - Phone:985-200-3382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5693101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5693OtherLICENSURE