Provider Demographics
NPI:1154980548
Name:HANSON, TAMMY ASHLYN (LCSW, MAC, LCAS, CCS)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:ASHLYN
Last Name:HANSON
Suffix:
Gender:F
Credentials:LCSW, MAC, LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5941
Mailing Address - Country:US
Mailing Address - Phone:704-372-6969
Mailing Address - Fax:704-335-0176
Practice Address - Street 1:2240 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5941
Practice Address - Country:US
Practice Address - Phone:704-372-6969
Practice Address - Fax:704-335-0176
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0069791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical