Provider Demographics
NPI:1710334230
Name:HANSEN, PAMALA (LCSW)
Entity Type:Individual
Prefix:
First Name:PAMALA
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 FRANKLIN STORE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-6370
Mailing Address - Country:US
Mailing Address - Phone:731-217-2517
Mailing Address - Fax:
Practice Address - Street 1:21 5TH ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-7442
Practice Address - Country:US
Practice Address - Phone:731-217-2517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN63081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical