Provider Demographics
NPI:1154173474
Name:HANNA, MARNELL MANAR
Entity type:Individual
Prefix:MR
First Name:MARNELL
Middle Name:MANAR
Last Name:HANNA
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MARS
Other - Middle Name:
Other - Last Name:HANNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:33464 SCHOENHERR RD STE 180
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-6392
Mailing Address - Country:US
Mailing Address - Phone:586-999-5971
Mailing Address - Fax:
Practice Address - Street 1:33464 SCHOENHERR RD STE 180
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-6392
Practice Address - Country:US
Practice Address - Phone:586-999-5971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician