Provider Demographics
NPI:1316765357
Name:HANNAH, ROGER WILLIAM JR (LPC)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:WILLIAM
Last Name:HANNAH
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 THISTLE DR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:PA
Mailing Address - Zip Code:17517-9185
Mailing Address - Country:US
Mailing Address - Phone:570-241-8093
Mailing Address - Fax:
Practice Address - Street 1:10 THISTLE DR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:PA
Practice Address - Zip Code:17517-9185
Practice Address - Country:US
Practice Address - Phone:570-241-8093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006835101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor