Provider Demographics
NPI:1386252633
Name:HANNAH, CHRYSTAL MARIE
Entity type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:MARIE
Last Name:HANNAH
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 1:155 DECK ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOPE
Mailing Address - State:WV
Mailing Address - Zip Code:25880-9239
Mailing Address - Country:US
Mailing Address - Phone:304-731-9111
Mailing Address - Fax:
Practice Address - Street 1:155 DECK ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOPE
Practice Address - State:WV
Practice Address - Zip Code:25880-9239
Practice Address - Country:US
Practice Address - Phone:304-731-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator