Provider Demographics
NPI:1578966040
Name:HANKERSON, SIDNETRICE
Entity Type:Individual
Prefix:
First Name:SIDNETRICE
Middle Name:
Last Name:HANKERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1946 BROOKSTONE WAY
Mailing Address - Street 2:107
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2679
Mailing Address - Country:US
Mailing Address - Phone:704-281-0416
Mailing Address - Fax:
Practice Address - Street 1:1946 BROOKSTONE WAY
Practice Address - Street 2:107
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2679
Practice Address - Country:US
Practice Address - Phone:704-281-0416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children