Provider Demographics
NPI:1043850076
Name:ETCHISON, HANNAH
Entity Type:Individual
Prefix:MS
First Name:HANNAH
Middle Name:
Last Name:ETCHISON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:LAWLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3425 COFFEE RD STE C2
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-1582
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1215 HIGHTOWER TRL
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-6244
Practice Address - Country:US
Practice Address - Phone:866-750-5554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician