Healthcare Provider Details

I. General information

NPI: 1003353343
Provider Name (Legal Business Name): HANS PETER PAULSEN LPC, CSAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2017
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 BUSH RIVER DR PO DRAWER 248
FARMVILLE VA
23901-3179
US

IV. Provider business mailing address

214 BUSH RIVER DR PO DRAWER 248
FARMVILLE VA
23901-3179
US

V. Phone/Fax

Practice location:
  • Phone: 434-392-3187
  • Fax: 434-392-5789
Mailing address:
  • Phone: 434-392-3187
  • Fax: 434-392-5789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710001282
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701006954
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: