Provider Demographics
NPI:1124604236
Name:HANZER, DEVON TYRE (MSW, LCASA, LCSWA)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:TYRE
Last Name:HANZER
Suffix:
Gender:M
Credentials:MSW, LCASA, LCSWA
Other - Prefix:
Other - First Name:DEVON
Other - Middle Name:TYRE
Other - Last Name:DUKER-HANZER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW,LCASA,LCSWA
Mailing Address - Street 1:8020 ANGLE PARK DR
Mailing Address - Street 2:B04
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617
Mailing Address - Country:US
Mailing Address - Phone:302-399-7731
Mailing Address - Fax:
Practice Address - Street 1:800 N MANGUM ST STE 400
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-2260
Practice Address - Country:US
Practice Address - Phone:919-683-1607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0158771041C0700X
NCLCAS-26933101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical