Provider Demographics
NPI:1356510697
Name:BRAGG, HANNELORE KNOLKE (MS SSP)
Entity Type:Individual
Prefix:MS
First Name:HANNELORE
Middle Name:KNOLKE
Last Name:BRAGG
Suffix:
Gender:F
Credentials:MS SSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 EAST TREMONT AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203
Mailing Address - Country:US
Mailing Address - Phone:704-342-1812
Mailing Address - Fax:704-342-1884
Practice Address - Street 1:212 EAST TREMONT AVE
Practice Address - Street 2:SUITE C
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203
Practice Address - Country:US
Practice Address - Phone:704-342-1812
Practice Address - Fax:704-342-1884
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0723103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist