Provider Demographics
NPI:1972690360
Name:HANSON, MARY THRELKELD (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:THRELKELD
Last Name:HANSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2434 DULUTH HIGHWAY 120 STE 108
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4067
Mailing Address - Country:US
Mailing Address - Phone:770-495-7877
Mailing Address - Fax:770-495-8383
Practice Address - Street 1:2434 DULUTH HIGHWAY 120 STE 108
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4067
Practice Address - Country:US
Practice Address - Phone:770-495-7877
Practice Address - Fax:770-495-8383
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical