Provider Demographics
NPI:1134963002
Name:HANNIBAL, CAROLYN A (NONE LICENSE)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:A
Last Name:HANNIBAL
Suffix:
Gender:F
Credentials:NONE LICENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-3849
Mailing Address - Country:US
Mailing Address - Phone:318-512-7646
Mailing Address - Fax:318-974-5079
Practice Address - Street 1:343 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-3849
Practice Address - Country:US
Practice Address - Phone:318-974-5075
Practice Address - Fax:318-974-5079
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health