Provider Demographics
NPI:1851880140
Name:SHRECKENGOST, HANNAH KAYE
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:KAYE
Last Name:SHRECKENGOST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1174 SHIPYARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-6471
Mailing Address - Country:US
Mailing Address - Phone:919-428-1169
Mailing Address - Fax:
Practice Address - Street 1:3904 OLEANDER DR STE 102
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6735
Practice Address - Country:US
Practice Address - Phone:910-313-3232
Practice Address - Fax:910-313-6598
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician