Provider Demographics
NPI:1528272853
Name:HANSEN, CAROLE ANN (MA EDS MA LPC)
Entity type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:ANN
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MA EDS MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 LK. EASTBROOK BLVE. SE,
Mailing Address - Street 2:SUITE #140
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:616-957-5773
Mailing Address - Fax:616-957-4466
Practice Address - Street 1:3501 LAKE EASTBROOK BLVD SE
Practice Address - Street 2:SUITE #140
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5938
Practice Address - Country:US
Practice Address - Phone:616-957-5773
Practice Address - Fax:616-957-4466
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005193101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional