Provider Demographics
NPI:1912913930
Name:HANSON, TODD DALE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:DALE
Last Name:HANSON
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2624
Mailing Address - Country:US
Mailing Address - Phone:803-765-0700
Mailing Address - Fax:803-765-1607
Practice Address - Street 1:1709 LAUREL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2624
Practice Address - Country:US
Practice Address - Phone:803-765-0700
Practice Address - Fax:803-765-1607
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3577106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist