Provider Demographics
NPI:1487023354
Name:HANKERSON, KHADIJA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KHADIJA
Middle Name:
Last Name:HANKERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 SHIPPAN AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-6075
Mailing Address - Country:US
Mailing Address - Phone:203-517-3363
Mailing Address - Fax:
Practice Address - Street 1:401 SHIPPAN AVE STE 204
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-6075
Practice Address - Country:US
Practice Address - Phone:203-516-3363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT108021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical