Provider Demographics
NPI:1205595352
Name:HILLER, ADAM (LCSW)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:HILLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24560 SOUTHPOINT DR STE 260
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-3505
Mailing Address - Country:US
Mailing Address - Phone:571-248-7472
Mailing Address - Fax:571-248-7493
Practice Address - Street 1:121 FORT EVANS RD SE APT D
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-4136
Practice Address - Country:US
Practice Address - Phone:716-598-1589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114741104100000X
VA09040169891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker