Provider Demographics
NPI:1285512764
Name:TRISVAN, DAQUAN
Entity type:Individual
Prefix:MR
First Name:DAQUAN
Middle Name:
Last Name:TRISVAN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DAQUAN
Other - Middle Name:
Other - Last Name:TRISVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14492 BLUE STAR HWY
Mailing Address - Street 2:
Mailing Address - City:STONY CREEK
Mailing Address - State:VA
Mailing Address - Zip Code:23882-3008
Mailing Address - Country:US
Mailing Address - Phone:804-704-3226
Mailing Address - Fax:
Practice Address - Street 1:14492 BLUE STAR HWY
Practice Address - Street 2:
Practice Address - City:STONY CREEK
Practice Address - State:VA
Practice Address - Zip Code:23882-3008
Practice Address - Country:US
Practice Address - Phone:804-704-3226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-23
Last Update Date:2025-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA13866101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health