Provider Demographics
NPI:1861502775
Name:HANSEN, CYNTHIA A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:A
Last Name:HANSEN
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 1:1878 E OCEAN VIEW AVE
Mailing Address - Street 2:A
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-2564
Mailing Address - Country:US
Mailing Address - Phone:757-583-1878
Mailing Address - Fax:757-583-0887
Practice Address - Street 1:1878 E OCEAN VIEW AVE
Practice Address - Street 2:A
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23503-2564
Practice Address - Country:US
Practice Address - Phone:757-583-1878
Practice Address - Fax:757-583-0887
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040016041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA89-0028-1Medicaid
VA89-0028-1Medicaid