Provider Demographics
NPI:1780959619
Name:DOHERTY, HANNAH WALLIS (BA)
Entity type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:WALLIS
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MS
Other - First Name:HANNAH
Other - Middle Name:WALLIS MELZER
Other - Last Name:SHEARER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:241 A. CLARENCE ST.
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:241 A. CLARENCE ST.
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420
Practice Address - Country:US
Practice Address - Phone:805-781-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-10
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health