Healthcare Provider Details

I. General information

NPI: 1740042290
Provider Name (Legal Business Name): HANNAH LAXSON ALC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 7TH AVE SE
DECATUR AL
35601-4216
US

IV. Provider business mailing address

150 CHERRY ST
ROGERSVILLE AL
35652-7311
US

V. Phone/Fax

Practice location:
  • Phone: 256-822-2909
  • Fax:
Mailing address:
  • Phone: 731-727-4009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberALC04761
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: