Healthcare Provider Details

I. General information

NPI: 1184335531
Provider Name (Legal Business Name): HANNAH JOYCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 BORO PL
MC LEAN VA
22102-3626
US

IV. Provider business mailing address

620 N STATE ROUTE 31
CRYSTAL LAKE IL
60012-3714
US

V. Phone/Fax

Practice location:
  • Phone: 323-601-0060
  • Fax:
Mailing address:
  • Phone: 815-261-3450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: