Provider Demographics
NPI:1467599548
Name:HERNANDEZ, JOANNA (BA)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 WATERS EDGE DRIVE
Mailing Address - Street 2:APT B
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8832
Mailing Address - Country:US
Mailing Address - Phone:931-801-5654
Mailing Address - Fax:
Practice Address - Street 1:585 SOUTH RIVERSIDE DRIVE SUITE G
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3107
Practice Address - Country:US
Practice Address - Phone:931-503-0777
Practice Address - Fax:931-503-0703
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health