Provider Demographics
NPI:1821621780
Name:HARTIG, NADINE ANA (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:NADINE
Middle Name:ANA
Last Name:HARTIG
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 PERSHING AVE
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-3538
Mailing Address - Country:US
Mailing Address - Phone:540-239-5238
Mailing Address - Fax:
Practice Address - Street 1:1028 GROVE AVE APT B
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-4714
Practice Address - Country:US
Practice Address - Phone:540-269-6888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004821101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional