Provider Demographics
NPI:1710345475
Name:HANSEN, HOLLY (LPCI)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 NEWARK AVE
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-4513
Mailing Address - Country:US
Mailing Address - Phone:843-797-7871
Mailing Address - Fax:843-797-8638
Practice Address - Street 1:35 NEWARK AVE
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-4513
Practice Address - Country:US
Practice Address - Phone:843-797-7871
Practice Address - Fax:843-797-8638
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6305101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional