Provider Demographics
NPI:1184791030
Name:STATON, DEIRDRE ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:DEIRDRE
Middle Name:ANN
Last Name:STATON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22802
Mailing Address - Country:US
Mailing Address - Phone:540-434-1941
Mailing Address - Fax:540-433-8277
Practice Address - Street 1:1241 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802
Practice Address - Country:US
Practice Address - Phone:540-434-1941
Practice Address - Fax:540-433-8277
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040038681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAO802775MOtherSENTARA
VA004945166Medicaid
VA248828OtherANTHEM
VAO802775MOtherSENTARA