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Individual

KIM P HAGER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
L.P.C.

Contact information

Practice address
102 HERITAGE WAY NE, 302, LEESBURG, VA 20176-4544
(703) 777-5100
(703) 777-0170
Mailing address
102 HERITAGE WAY NE, 302, LEESBURG, VA 20176-4544
(703) 771-5100
(703) 777-0170

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701003195
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
261770
ANTHEM
VA
01
261771
ANTHEM
VA
01
293865
AMERIGROUP
VA
Enumeration date
08/30/2006
Last updated
09/10/2007
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