Provider Demographics
NPI:1912497066
Name:HANSON, ADAM MICHAEL (LPC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:MICHAEL
Last Name:HANSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 NEW JERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-2718
Mailing Address - Country:US
Mailing Address - Phone:757-305-8586
Mailing Address - Fax:
Practice Address - Street 1:317 OFFICE SQUARE LN STE 202B
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3663
Practice Address - Country:US
Practice Address - Phone:757-453-4081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2023-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007651101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA601285484Medicaid