Provider Demographics
NPI:1063574127
Name:HANNA, BEVERLY ANN (LISW-CP)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ANN
Last Name:HANNA
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6439 GARNERS FERRY ROAD
Mailing Address - Street 2:WILLIAM JENNINGS BRYAN DORN VA MEDICAL CENTER
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-1639
Mailing Address - Country:US
Mailing Address - Phone:803-776-4000
Mailing Address - Fax:803-695-6871
Practice Address - Street 1:6439 GARNERS FERRY RD
Practice Address - Street 2:WILLIAM JENNINGS BRYAN DORN VA MEDICAL CENTER
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1638
Practice Address - Country:US
Practice Address - Phone:803-776-4000
Practice Address - Fax:803-695-6871
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC45521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical