Provider Demographics
NPI:1821709965
Name:HANULA, KRISTIN LINAMARIA (MSW, LISW-CP, LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LINAMARIA
Last Name:HANULA
Suffix:
Gender:F
Credentials:MSW, LISW-CP, LCSW
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:LINAMARIA
Other - Last Name:HANULA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:171 ASHLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-8908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:171 ASHLEY AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8908
Practice Address - Country:US
Practice Address - Phone:843-792-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040099821041C0700X
SC142481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical