Healthcare Provider Details

I. General information

NPI: 1821600842
Provider Name (Legal Business Name): HANNAH ASHLIN ECCLES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 N HIGHLAND ST
GASTONIA NC
28052-2179
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 704-772-4700
  • Fax:
Mailing address:
  • Phone: 704-874-1900
  • Fax: 704-864-7608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP015044
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: