Healthcare Provider Details

I. General information

NPI: 1700723426
Provider Name (Legal Business Name): MS. NAKIA MARIE VANHATTEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2523A PIN OAK CT
COLONIAL HEIGHTS VA
23834-1754
US

IV. Provider business mailing address

2523A PIN OAK CT
COLONIAL HEIGHTS VA
23834-1754
US

V. Phone/Fax

Practice location:
  • Phone: 804-629-2008
  • Fax:
Mailing address:
  • Phone: 804-629-2008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number1401228024
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: