Healthcare Provider Details

I. General information

NPI: 1306184999
Provider Name (Legal Business Name): MICHAEL HOTTMAN LPC, CSAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12390 STARTING GATE WAY
ASHLAND VA
23005-3003
US

IV. Provider business mailing address

12390 STARTING GATE WAY
ASHLAND VA
23005-3003
US

V. Phone/Fax

Practice location:
  • Phone: 804-767-5710
  • Fax:
Mailing address:
  • Phone: 804-767-5710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710102683
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701005392
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: