Provider Demographics
NPI:1578000188
Name:ELLIS, HANNAH BANES (LCSW)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:BANES
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:BANES
Other - Last Name:KRUMBHAAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4434 IDEWILD LOOP APT 304
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-7205
Mailing Address - Country:US
Mailing Address - Phone:828-712-7031
Mailing Address - Fax:
Practice Address - Street 1:112 TOP OF THE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-5443
Practice Address - Country:US
Practice Address - Phone:828-513-0653
Practice Address - Fax:828-656-6265
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-22
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-22920101YA0400X
IDLCSW-393781041C0700X
NCC0117661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13956044OtherCAQH