Provider Demographics
NPI:1194358655
Name:HERNANDEZ, ADRIAN V (CO60692009)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:V
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:CO60692009
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7017 NE HIGHWAY 99 STE 114
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-0554
Mailing Address - Country:US
Mailing Address - Phone:360-694-7484
Mailing Address - Fax:360-694-7479
Practice Address - Street 1:7017 NE HIGHWAY 99 STE 114
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-0554
Practice Address - Country:US
Practice Address - Phone:360-694-7484
Practice Address - Fax:360-694-7479
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60692009101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)