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General NPI Number Information
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NPI Number | 1376826719
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Entity Type | Individual
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Provider Name | ODESSA MAVIS THOMAS HANCOCK LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/22/2011
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Last Update Date | 06/26/2024
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Provider Practice Location Address
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Address Line | 13395 N MARANA MAIN ST BLDG B
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City | MARANA
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State | AZ
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Zip | 85653-7008
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Country | US
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Telephone | 520-682-1091
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Fax |
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Provider Business Mailing Address
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Address Line | 13395 N MARANA MAIN ST BLDG B
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City | MARANA
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State | AZ
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Zip | 85653-7008
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Country | US
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Telephone | 520-682-1091
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | P005543
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | P015881
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LMSW-19637
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 1217085
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-22353
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License Number State | AZ
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Taxonomy #6
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCAS-15573
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License Number State | NC
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