Healthcare Provider Details

I. General information

NPI: 1518661693
Provider Name (Legal Business Name): DANIELLE MALENA HULSE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANIELLE HUBBELL

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 CHIPPEWA TRL
PORTSMOUTH VA
23701-2412
US

IV. Provider business mailing address

18 CHIPPEWA TRL
PORTSMOUTH VA
23701-2412
US

V. Phone/Fax

Practice location:
  • Phone: 757-713-2014
  • Fax: 757-392-0702
Mailing address:
  • Phone: 757-713-2014
  • Fax: 757-392-0702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701012312
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: