Provider Demographics
NPI:1720307689
Name:HESTER, MICHAEL THEODORE (LCP, LCPC, LPN)
Entity Type:Individual
Prefix:PROF
First Name:MICHAEL
Middle Name:THEODORE
Last Name:HESTER
Suffix:
Gender:M
Credentials:LCP, LCPC, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1359 W 40TH ST # A
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-2340
Mailing Address - Country:US
Mailing Address - Phone:757-533-1399
Mailing Address - Fax:
Practice Address - Street 1:1359 W 40TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23508-2340
Practice Address - Country:US
Practice Address - Phone:757-533-1399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005961101YP2500X
MDLC3472101YP2500X
TX1003-0705101YA0400X
GALPN070659164X00000X
VA0701010939101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No164X00000XNursing Service ProvidersLicensed Vocational Nurse