Provider Information for 1831525492
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CONNIE J HANNON LMHC
Sex: Female
NPI: 1831525492
Last Updated: 2020-12-24
Certification Date: 2020-12-24
Certification Date: 2020-12-24
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1831525492 | ||||||||||||||
| Enumeration Date | 2013-09-16 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | NO | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 135 N CHURCH ST STARKE, FL 32091-3411 United States Phone: 352-575-3413 | Fax: | ||||||||||||||
| Primary Practice Address | 410 E JEFFERSON ST STARKE, FL 32091-3333 United States Phone: 283-524-8996 | Fax: | ||||||||||||||
| Secondary Practice Address(es) | 4300 SW 13TH ST | ||||||||||||||
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