Provider Demographics
NPI:1316473952
Name:HANCOCK, ANA
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:HANCOCK
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:PO BOX 5265
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-5265
Mailing Address - Country:US
Mailing Address - Phone:843-601-2059
Mailing Address - Fax:
Practice Address - Street 1:701 COVENTRY LN
Practice Address - Street 2:A-5
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-8893
Practice Address - Country:US
Practice Address - Phone:843-601-2059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCINTERPRETER405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCBABYNETMedicaid