Healthcare Provider Details

I. General information

NPI: 1710054069
Provider Name (Legal Business Name): JEANETTE R HANNA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5210 WOODSIDE EXECUTIVE CT
AIKEN SC
29803-3816
US

IV. Provider business mailing address

721 MAPLE ST
AIKEN SC
29803-5441
US

V. Phone/Fax

Practice location:
  • Phone: 803-226-0275
  • Fax: 800-858-6654
Mailing address:
  • Phone: 803-226-0275
  • Fax: 800-858-6654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5004
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: