Healthcare Provider Details

I. General information

NPI: 1609083245
Provider Name (Legal Business Name): ANDREA SUSAN HANSEN FORD LPC LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 HARRISON AVE
ELKINS WV
26241
US

IV. Provider business mailing address

307 MARRO DRIVE
ELKINS WV
26241
US

V. Phone/Fax

Practice location:
  • Phone: 304-636-9450
  • Fax: 304-636-7057
Mailing address:
  • Phone: 304-636-9450
  • Fax: 304-636-7057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC1679
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWAP00942468
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: