Provider Demographics
NPI:1407591746
Name:CLARKE, HANNAH ELISE
Entity Type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:ELISE
Last Name:CLARKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:ELISE
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:201 CLEBURNE AVE NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-2317
Mailing Address - Country:US
Mailing Address - Phone:404-909-7512
Mailing Address - Fax:
Practice Address - Street 1:3459 ACWORTH DUE WEST RD NW STE 210
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-5826
Practice Address - Country:US
Practice Address - Phone:404-909-7512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health