Provider Demographics
NPI:1629775507
Name:HANNA, JOCELYN NAOMI
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:NAOMI
Last Name:HANNA
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 1:18 WATERFORD PL
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-5703
Mailing Address - Country:US
Mailing Address - Phone:843-885-8837
Mailing Address - Fax:
Practice Address - Street 1:18 WATERFORD PL
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-5703
Practice Address - Country:US
Practice Address - Phone:843-885-8837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8094101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health