Provider Demographics
NPI:1598857872
Name:HOOPER, KATHLEEN A (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:HOOPER
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 1:142 W YORK ST
Mailing Address - Street 2:SUITE 915
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2015
Mailing Address - Country:US
Mailing Address - Phone:757-313-5700
Mailing Address - Fax:757-313-5702
Practice Address - Street 1:142 W YORK ST
Practice Address - Street 2:SUITE 915
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2015
Practice Address - Country:US
Practice Address - Phone:757-313-5700
Practice Address - Fax:757-313-5702
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040016151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008944075Medicaid
VA800003011Medicare ID - Type Unspecified