Healthcare Provider Details

I. General information

NPI: 1659928497
Provider Name (Legal Business Name): VERNA M HEGSTROM MA, NCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 SAND HILL RD
ANNANDALE NJ
08801-3111
US

IV. Provider business mailing address

23 SAND HILL RD
ANNANDALE NJ
08801-3111
US

V. Phone/Fax

Practice location:
  • Phone: 908-200-9118
  • Fax:
Mailing address:
  • Phone: 908-200-9118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00324000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: