Healthcare Provider Details

I. General information

NPI: 1144580432
Provider Name (Legal Business Name): ADAM D HALVORSEN MACP, LMHC, CDP, CPS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1498 SE TECH CENTER PL STE 180
VANCOUVER WA
98683-5518
US

IV. Provider business mailing address

305 SE CHKALOV DR STE 111NO111
VANCOUVER WA
98683-5292
US

V. Phone/Fax

Practice location:
  • Phone: 360-619-2226
  • Fax: 360-326-9691
Mailing address:
  • Phone: 360-844-0153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO 60158865
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number7889
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60930372
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: