1114206778 NPI number — HANOVER COUNSELING ASSOCIATES, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114206778 NPI number — HANOVER COUNSELING ASSOCIATES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HANOVER COUNSELING ASSOCIATES, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114206778
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7109 STUDLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MECHANICSVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23116-6514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-310-5351
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7109 STUDLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MECHANICSVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23116-6514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-310-5351
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MASOURAS
Authorized Official First Name:
LISA
Authorized Official Middle Name:
CORSO
Authorized Official Title or Position:
BUSINESS DIRECTOR/OWNER
Authorized Official Telephone Number:
804-310-5351

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  0904006510 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com