Provider Demographics
NPI:1114243011
Name:HANCOCK, MARISA (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:MARISA
Middle Name:
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 15TH AVE E
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-5802
Mailing Address - Country:US
Mailing Address - Phone:206-240-2662
Mailing Address - Fax:
Practice Address - Street 1:324 15TH AVE E
Practice Address - Street 2:SUITE 201
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-5802
Practice Address - Country:US
Practice Address - Phone:206-240-2662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60140854101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health