Healthcare Provider Details

I. General information

NPI: 1205274172
Provider Name (Legal Business Name): MONICA MARIE MEJIA-HANNAMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 08/11/2024
Certification Date: 08/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 ORCHARD DR
ELIZABETH CITY NC
27909-9325
US

IV. Provider business mailing address

206 ORCHARD DR
ELIZABETH CITY NC
27909-9325
US

V. Phone/Fax

Practice location:
  • Phone: 562-743-0806
  • Fax:
Mailing address:
  • Phone: 562-743-0806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101825
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: