Provider Demographics
NPI:1366943896
Name:HANFORD, ANN SODAT
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:SODAT
Last Name:HANFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 MILL REEF RD
Mailing Address - Street 2:
Mailing Address - City:SANDSTON
Mailing Address - State:VA
Mailing Address - Zip Code:23150-5510
Mailing Address - Country:US
Mailing Address - Phone:804-514-3909
Mailing Address - Fax:
Practice Address - Street 1:4800 W HUNDRED RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1746
Practice Address - Country:US
Practice Address - Phone:804-353-3585
Practice Address - Fax:804-353-3588
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002269101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional