MEDICARE: HANNAH CLARK, LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1972319051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANNAH CLARK, LLC

Provider Business Mailing Address
First Line	:	4591 RIVER PKWY APT K
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-3884
Country	:	US
Telephone Number	:	423-723-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	4591 RIVER PKWY APT K
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-3884
Country	:	US
Telephone Number	:	423-723-9800
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH THERAPIST
Name	:	HANNAH CLARK
Credential	:	LPC
Telephone Number	:	423-723-9800

Provider Enumeration Date	:	12/04/2024
Last Update Date	:	12/04/2024

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