Provider Demographics
NPI:1568186179
Name:DESISTO, NATALIE ALEXANDRA (LCMHC, NCC)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:ALEXANDRA
Last Name:DESISTO
Suffix:
Gender:F
Credentials:LCMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 LOCUST COVE RD
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-8828
Mailing Address - Country:US
Mailing Address - Phone:804-269-6758
Mailing Address - Fax:
Practice Address - Street 1:25 LOCUST COVE RD
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-8828
Practice Address - Country:US
Practice Address - Phone:804-269-6758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17710101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health