Provider Demographics
NPI:1902365018
Name:HANNAH EXECUTIVE GROUP, LLC
Entity Type:Organization
Organization Name:HANNAH EXECUTIVE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENYOTTA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNAH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:404-964-0906
Mailing Address - Street 1:PO BOX 33
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:GA
Mailing Address - Zip Code:30424
Mailing Address - Country:US
Mailing Address - Phone:404-462-4779
Mailing Address - Fax:877-268-1292
Practice Address - Street 1:1514 CLEVELAND AVENUE
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344
Practice Address - Country:US
Practice Address - Phone:404-462-4779
Practice Address - Fax:877-268-1293
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANNAH EXECUTIVE GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-18
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty