Provider Demographics
NPI:1841977402
Name:BARRETO-WHITAKER, ALICIA (CSAC-SUPERVISEE)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:BARRETO-WHITAKER
Suffix:
Gender:F
Credentials:CSAC-SUPERVISEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 N HAMILTON ST STE B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-2662
Mailing Address - Country:US
Mailing Address - Phone:804-205-4713
Mailing Address - Fax:
Practice Address - Street 1:204 N HAMILTON ST STE B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-2662
Practice Address - Country:US
Practice Address - Phone:804-409-2575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0709025524101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)