Healthcare Provider Details

I. General information

NPI: 1336086925
Provider Name (Legal Business Name): MRS. CATRINA CRYSTAL HANNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATRINA CRYSTAL ANCHONDO

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 BOARDWALK DR
RIDGELAND SC
29936-7993
US

IV. Provider business mailing address

124 BOARDWALK DR
RIDGELAND SC
29936-7993
US

V. Phone/Fax

Practice location:
  • Phone: 866-672-0283
  • Fax:
Mailing address:
  • Phone: 866-672-0283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: