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General NPI Number Information
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NPI Number | 1053656629
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Entity Type | Individual
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Provider Name | VICKIE JEAN HAGAN M.A., LPC, CSOPT
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Gender | Female
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Dates
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Enumeration Date | 12/07/2012
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Last Update Date | 12/07/2012
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Provider Practice Location Address
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Address Line | 21 FORT EVANS RD NE STE B
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City | LEESBURG
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State | VA
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Zip | 20176-4488
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Country | US
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Telephone | 703-443-6917
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 4696
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City | WINCHESTER
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State | VA
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Zip | 22604
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Country | US
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Telephone | 540-931-7193
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701005378
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C2976
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License Number State | OR
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