Provider Demographics
NPI:1073013934
Name:HANSON, KAITLIN (LCMHC, CCTP)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:LCMHC, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 RALEIGH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-9047
Mailing Address - Country:US
Mailing Address - Phone:910-225-4591
Mailing Address - Fax:
Practice Address - Street 1:362 RALEIGH ST
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-9047
Practice Address - Country:US
Practice Address - Phone:919-612-6557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-17
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13515101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health