Provider Demographics
NPI:1790338606
Name:HANKINS, LOREN DAVID (SUDP)
Entity Type:Individual
Prefix:MR
First Name:LOREN
Middle Name:DAVID
Last Name:HANKINS
Suffix:
Gender:M
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 N 20TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-3376
Mailing Address - Country:US
Mailing Address - Phone:095-373-0255
Mailing Address - Fax:833-860-0492
Practice Address - Street 1:1600 N 20TH AVE STE A
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-3376
Practice Address - Country:US
Practice Address - Phone:509-537-3025
Practice Address - Fax:338-660-4928
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-19
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO6098177101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)