Provider Demographics
NPI:1760565469
Name:ACKERMAN, ANN DEWEESE (LPC)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:DEWEESE
Last Name:ACKERMAN
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 1:111 76TH ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1960
Mailing Address - Country:US
Mailing Address - Phone:757-425-6485
Mailing Address - Fax:
Practice Address - Street 1:2580 POTTERS RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4324
Practice Address - Country:US
Practice Address - Phone:757-498-9391
Practice Address - Fax:757-498-7073
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001163101YP2500X
VA0717000291106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA258900OtherANTHEM NUMBER
VA004945395Medicaid
VA084251OtherOPTIMA