MEDICARE: MS. HANNAH PEGRAM MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C016399	NC

General Provider Information

NPI Number	:	1205429859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HANNAH PEGRAM MSW, LCSW

Provider Business Mailing Address
First Line	:	903 NORTHEAST DR STE 201
Second Line	:
City	:	DAVIDSON
State	:	NC
Zip	:	28036-7438
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	318 S SOUTH ST STE 6B-1113
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-4379
Country	:	US
Telephone Number	:	980-349-7060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2021
Last Update Date	:	06/16/2025

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