Individual
MR. RICKY LAVORN COSTON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11164 WILLOW DR APT T, BEALETON, VA 22712-9210
(757) 746-0113
Mailing address
11164 WILLOW DR APT T, BEALETON, VA 22712-9210
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
0704016397
VA
101YS0200X
School Counselor
Primary
PPS-0605419
VA
Other
Enumeration date
12/14/2023
Last updated
12/14/2023
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