Healthcare Provider Details

I. General information

NPI: 1487908992
Provider Name (Legal Business Name): STEPHANIE HAMMERK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 06/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N 22ND ST
RICHMOND VA
23223
US

IV. Provider business mailing address

200 N 22ND ST
RICHMOND VA
23223-7020
US

V. Phone/Fax

Practice location:
  • Phone: 804-591-3943
  • Fax:
Mailing address:
  • Phone: 804-591-9343
  • Fax: 804-649-2151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberISW6820
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904008868
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: