Provider Demographics
NPI:1336653476
Name:ROSE, HANNA (MA, LPCA)
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:MA, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5441 STRAWBERRY HILL DR APT D
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-4584
Mailing Address - Country:US
Mailing Address - Phone:281-615-1817
Mailing Address - Fax:
Practice Address - Street 1:4108 PARK RD STE 411
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-2262
Practice Address - Country:US
Practice Address - Phone:704-776-2464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13550101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor