Provider Demographics
NPI:1003241787
Name:HORTON, VIRGINIA A (LCSW)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:A
Last Name:HORTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:VIRGINIA
Other - Middle Name:A
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4213 PRAIRIE CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-8929
Mailing Address - Country:US
Mailing Address - Phone:209-613-4255
Mailing Address - Fax:209-567-1015
Practice Address - Street 1:2020 COFFEE ROAD, SUITE H-4
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355
Practice Address - Country:US
Practice Address - Phone:209-613-4255
Practice Address - Fax:209-567-1015
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS21278101YA0400X, 101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health