Provider Demographics
NPI:1235338666
Name:HANNA, GAIL DENISE (LCASA)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:DENISE
Last Name:HANNA
Suffix:
Gender:F
Credentials:LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:115 PEMBROKE POINTE LN
Mailing Address - Street 2:3C
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7359
Mailing Address - Country:US
Mailing Address - Phone:919-561-2204
Mailing Address - Fax:919-561-2204
Practice Address - Street 1:201 LIVERMORE DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-7322
Practice Address - Country:US
Practice Address - Phone:910-272-6420
Practice Address - Fax:910-521-4630
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2564-A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)