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General NPI Number Information
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NPI Number | 1467847038
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Entity Type | Individual
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Provider Name | EDWARD JOSEPH HANKS III LMFT
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Gender | Male
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Dates
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Enumeration Date | 04/01/2015
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Last Update Date | 01/17/2019
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Provider Practice Location Address
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Address Line | 715 SILK TREE TRCE
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City | FUQUAY VARINA
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State | NC
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Zip | 27526-5094
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Country | US
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Telephone | 919-753-6238
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1084
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City | MORRISVILLE
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State | NC
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Zip | 27560-1084
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Country | US
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Telephone | 919-753-6238
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 10036A
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1967
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License Number State | NC
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