Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 0710001282 | VA |
Y | 101YP2500X | Professional Counselor | 0701006954 | VA |
NPI | 1003353343 |
---|---|
Provider Name | Hans Peter Paulsen |
First Address | Farmville, VA 23901-3179 |
Second Address | Farmville, VA 23901-3179 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2017 |
Last Update Date | 25/01/2017 |