Basic Information
| Provider Information | |||||||||
| NPI: | 1396871950 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANSON | ||||||||
| FirstName: | CHRISTIAN | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 272 VESTER ST | ||||||||
| Address2: | |||||||||
| City: | FERNDALE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482201714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864696265 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25600 WOODWARD AVE | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480670943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483997447 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 03/31/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801085605 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.