Provider Demographics
NPI:1023533643
Name:HAGANS, IMANI PATRICE (LPC)
Entity type:Individual
Prefix:
First Name:IMANI
Middle Name:PATRICE
Last Name:HAGANS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:IMANI
Other - Middle Name:
Other - Last Name:HAGANS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:8422 ELECTRIC AVE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-5109
Mailing Address - Country:US
Mailing Address - Phone:703-849-1312
Mailing Address - Fax:
Practice Address - Street 1:111 S FAIRFAX ST STE 2
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3301
Practice Address - Country:US
Practice Address - Phone:703-837-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701009073101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional