Provider Demographics
NPI:1487906756
Name:HANNA, VICKIE (LISW-SUPV, LCDCIII)
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:
Last Name:HANNA
Suffix:
Gender:F
Credentials:LISW-SUPV, LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5982 RHODES RD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-4128
Mailing Address - Country:US
Mailing Address - Phone:330-673-1347
Mailing Address - Fax:330-678-3677
Practice Address - Street 1:169 5TH ST SE
Practice Address - Street 2:UNIT B
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-9003
Practice Address - Country:US
Practice Address - Phone:330-673-1347
Practice Address - Fax:330-678-3677
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDC-011413-3101YA0400X
OHI.0010081-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)