Provider Demographics
NPI:1750966958
Name:HANNAH, SHANICE LAVON (SSP II, LPES)
Entity type:Individual
Prefix:MISS
First Name:SHANICE
Middle Name:LAVON
Last Name:HANNAH
Suffix:
Gender:F
Credentials:SSP II, LPES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 HERITAGE LN APT F6
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-3144
Mailing Address - Country:US
Mailing Address - Phone:843-373-8748
Mailing Address - Fax:
Practice Address - Street 1:1516 S LANGLEY DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-6149
Practice Address - Country:US
Practice Address - Phone:843-621-0263
Practice Address - Fax:843-536-8522
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4750103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool