Provider Demographics
NPI:1467037408
Name:HANKINS, KADEISA
Entity Type:Individual
Prefix:
First Name:KADEISA
Middle Name:
Last Name:HANKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 MILLSTONE RD APT L
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-3968
Mailing Address - Country:US
Mailing Address - Phone:843-304-7933
Mailing Address - Fax:
Practice Address - Street 1:1521 SAINT ANTHONY AVE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-2993
Practice Address - Country:US
Practice Address - Phone:843-304-7933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty