Provider Demographics
NPI:1467061226
Name:HANLEY, ELLEN (ATR-P, LCMHC-A)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:HANLEY
Suffix:
Gender:F
Credentials:ATR-P, LCMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7489 ROCKFISH RD
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-6131
Mailing Address - Country:US
Mailing Address - Phone:910-584-6739
Mailing Address - Fax:833-260-0543
Practice Address - Street 1:7489 ROCKFISH RD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-6131
Practice Address - Country:US
Practice Address - Phone:910-584-6739
Practice Address - Fax:833-260-0543
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14813101Y00000X, 101YM0800X
103TP2701X
19-055221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist