Provider Demographics
NPI:1912018458
Name:DELLAMANO, VIRGINIA LEE (LCPC CSADC)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:LEE
Last Name:DELLAMANO
Suffix:
Gender:F
Credentials:LCPC CSADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 GLEN ED PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034
Mailing Address - Country:US
Mailing Address - Phone:618-288-9460
Mailing Address - Fax:
Practice Address - Street 1:7 GLEN ED PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034
Practice Address - Country:US
Practice Address - Phone:618-288-9460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL351101YA0400X
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor