Provider Demographics
NPI:1952887341
Name:HANCHETT, KIMBERLY DAWN (SOCIAL WORKER)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DAWN
Last Name:HANCHETT
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:DAWN
Other - Last Name:HANCHETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSW
Mailing Address - Street 1:10027 CORVALLIS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-3368
Mailing Address - Country:US
Mailing Address - Phone:832-453-6385
Mailing Address - Fax:
Practice Address - Street 1:10027 CORVALLIS DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095
Practice Address - Country:US
Practice Address - Phone:832-453-6385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65958104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker