Provider Demographics
NPI:1770238560
Name:HANSON PSYCHOLOGICAL, PLLC
Entity Type:Organization
Organization Name:HANSON PSYCHOLOGICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D, LP
Authorized Official - Phone:910-352-4657
Mailing Address - Street 1:3205 RANDALL PKWY STE 207
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2569
Mailing Address - Country:US
Mailing Address - Phone:910-352-4657
Mailing Address - Fax:
Practice Address - Street 1:4415 GREY OAKS CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2543
Practice Address - Country:US
Practice Address - Phone:910-352-4657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-20
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1649258583OtherNPI