Healthcare Provider Details

I. General information

NPI: 1659886554
Provider Name (Legal Business Name): CHRISTAL HANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W MARTIN ST
MARTINSBURG WV
25401-2747
US

IV. Provider business mailing address

601 AVERY ST STE 201
PARKERSBURG WV
26101-5192
US

V. Phone/Fax

Practice location:
  • Phone: 304-249-4848
  • Fax: 304-254-6206
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00941687
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: