Provider Demographics
NPI:1396871950
Name:HANSON, CHRISTIAN (LMSW)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:HANSON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 VESTER ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1714
Mailing Address - Country:US
Mailing Address - Phone:586-469-6265
Mailing Address - Fax:
Practice Address - Street 1:25600 WOODWARD AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-0943
Practice Address - Country:US
Practice Address - Phone:248-399-7447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010856051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI7099Medicare PIN