Healthcare Provider Details

I. General information

NPI: 1033061346
Provider Name (Legal Business Name): HANNA WILSON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2026
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6821 BLACK HORSE PIKE
EGG HARBOR TOWNSHIP NJ
08234-4101
US

IV. Provider business mailing address

44 MEADOW RIDGE RD
GALLOWAY NJ
08205-3209
US

V. Phone/Fax

Practice location:
  • Phone: 844-422-3832
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: