Provider Demographics
NPI:1982727921
Name:HANSON, MIRIAM K (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:K
Last Name:HANSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11755 POINTE PL
Mailing Address - Street 2:SUITE B-2
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4636
Mailing Address - Country:US
Mailing Address - Phone:770-521-8700
Mailing Address - Fax:770-565-2660
Practice Address - Street 1:11755 POINTE PL
Practice Address - Street 2:SUITE B-2
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4636
Practice Address - Country:US
Practice Address - Phone:770-521-8700
Practice Address - Fax:770-565-2660
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000472101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health