Provider Demographics
NPI:1154799427
Name:HANNA, DARCIE (ADC-T)
Entity type:Individual
Prefix:
First Name:DARCIE
Middle Name:
Last Name:HANNA
Suffix:
Gender:F
Credentials:ADC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4984 RIVER OAKS ROAD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MN
Mailing Address - Zip Code:55373
Mailing Address - Country:US
Mailing Address - Phone:612-402-4011
Mailing Address - Fax:
Practice Address - Street 1:4984 RIVEROAKS ROAD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MN
Practice Address - Zip Code:55373-1100
Practice Address - Country:US
Practice Address - Phone:612-402-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)