Provider Demographics
NPI:1730658154
Name:DELK, DEATRICE (LPC)
Entity Type:Individual
Prefix:MS
First Name:DEATRICE
Middle Name:
Last Name:DELK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8419 CAPERNWRAY DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-5612
Mailing Address - Country:US
Mailing Address - Phone:804-382-0098
Mailing Address - Fax:804-732-0087
Practice Address - Street 1:20 W BANK ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-3279
Practice Address - Country:US
Practice Address - Phone:804-862-8000
Practice Address - Fax:804-722-4291
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-14
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007936101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA$$$$$$$$$Medicaid