Provider Demographics
NPI:1083822720
Name:LACROIX, DANIEL
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:LACROIX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2671 AVENIR PL # B
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-7485
Mailing Address - Country:US
Mailing Address - Phone:703-207-8600
Mailing Address - Fax:703-207-9224
Practice Address - Street 1:2671 AVENIR PL # B
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-7485
Practice Address - Country:US
Practice Address - Phone:703-207-8600
Practice Address - Fax:703-207-9224
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
VA09040072321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945182Medicaid