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General NPI Number Information
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NPI Number | 1891497384
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Entity Type | Individual
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Provider Name | WAITHIRA WANYEE HANSEN
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Gender | Female
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 215 MOUNTAIN DR STE 106
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City | DESTIN
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State | FL
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Zip | 32541-2346
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Country | US
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Telephone | 850-837-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 123 WRIGHT CIR
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City | NICEVILLE
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State | FL
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Zip | 32578-4231
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Country | US
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Telephone | 781-864-5133
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH21945
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License Number State | FL
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