Provider Demographics
NPI:1992809925
Name:ACKERMAN, DARLENE (MS, CRC)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:MS, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 CHATHAM SQUARE OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-2561
Mailing Address - Country:US
Mailing Address - Phone:540-899-9826
Mailing Address - Fax:540-373-3913
Practice Address - Street 1:412 CHATHAM SQUARE OFFICE PARK
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-2561
Practice Address - Country:US
Practice Address - Phone:540-899-9826
Practice Address - Fax:540-373-3913
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002033101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA340207OtherTRICARE PROVIDER #
VAANTHEMOtherANTHEM BC/BS PROVIDER #