Healthcare Provider Details

I. General information

NPI: 1114738432
Provider Name (Legal Business Name): KELLI HANNA EDWARDS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLI MICHELLE HANNA LBSW

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 6TH AVE S
BIRMINGHAM AL
35233-1601
US

IV. Provider business mailing address

3041 HOLMANS XRD
GOODWATER AL
35072-5073
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-1917
  • Fax:
Mailing address:
  • Phone: 334-301-8653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6672C
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0903003847
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17370
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: