Provider Demographics
NPI:1215303599
Name:HANSON, DEBBIE
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29000 US HIGHWAY 98
Mailing Address - Street 2:SUITE A102
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-7272
Mailing Address - Country:US
Mailing Address - Phone:251-626-5797
Mailing Address - Fax:251-626-5798
Practice Address - Street 1:29000 US HIGHWAY 98
Practice Address - Street 2:SUITE A102
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-7272
Practice Address - Country:US
Practice Address - Phone:251-626-5797
Practice Address - Fax:251-626-5798
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3419101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional