Provider Demographics
NPI:1508382888
Name:HANNA, KRISTEN (LMSW)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:HANNA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4006 HIGHWAY 34 E
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-3531
Mailing Address - Country:US
Mailing Address - Phone:404-960-1282
Mailing Address - Fax:
Practice Address - Street 1:1645 HUNTER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906
Practice Address - Country:US
Practice Address - Phone:706-569-0727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0076011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty