Basic Information
| Provider Information | |||||||||
| NPI: | 1124798772 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANN | ||||||||
| FirstName: | CAROLINE | ||||||||
| MiddleName: | LEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 JEFFERSON ST STE 2C | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245041724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552847483 | ||||||||
| FaxNumber: | 6178070958 | ||||||||
| Practice Location | |||||||||
| Address1: | 922 NATIONAL HWY | ||||||||
| Address2: | |||||||||
| City: | LAVALE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 215027325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2403627294 | ||||||||
| FaxNumber: | 2403627366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2021 | ||||||||
| LastUpdateDate: | 07/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 27043 | MD | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 44SC05358200 | NJ | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 2E1604 | 05 | MD | MEDICAID |