Provider Demographics
NPI:1679865646
Name:HANNIBAL, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HANNIBAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 648
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-0648
Mailing Address - Country:US
Mailing Address - Phone:310-913-4050
Mailing Address - Fax:
Practice Address - Street 1:4 NORTHCREST DR
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-4500
Practice Address - Country:US
Practice Address - Phone:310-913-4050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor