Provider Demographics
NPI:1730639667
Name:HANSON, HANNAH (LCDP)
Entity Type:Individual
Prefix:MISS
First Name:HANNAH
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 PLAINFIELD ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-6703
Mailing Address - Country:US
Mailing Address - Phone:401-946-0650
Mailing Address - Fax:401-946-2407
Practice Address - Street 1:985 PLAINFIELD ST
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-6703
Practice Address - Country:US
Practice Address - Phone:401-946-0650
Practice Address - Fax:401-946-2407
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP00662101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)