Provider Demographics
NPI:1154376523
Name:HANNA, ROBERT VAUGHN (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:VAUGHN
Last Name:HANNA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 HAYWOOD RD STE E
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-7110
Mailing Address - Country:US
Mailing Address - Phone:828-768-1827
Mailing Address - Fax:806-209-3389
Practice Address - Street 1:775 HAYWOOD RD STE E
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-7110
Practice Address - Country:US
Practice Address - Phone:828-768-1827
Practice Address - Fax:806-209-3389
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2679103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000850Medicaid