Provider Demographics
NPI:1982133088
Name:HANNUM, CARISSA (MA, LCPC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:CARISSA
Middle Name:
Last Name:HANNUM
Suffix:
Gender:F
Credentials:MA, LCPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 CONNECTICUT AVE NW STE 203
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-1762
Mailing Address - Country:US
Mailing Address - Phone:202-677-5049
Mailing Address - Fax:
Practice Address - Street 1:1350 CONNECTICUT AVE NW STE 203
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-1762
Practice Address - Country:US
Practice Address - Phone:202-677-5049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC9923101YM0800X
DCPRC15264101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health