Basic Information
| Provider Information | |||||||||
| NPI: | 1992224133 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANNAFORD | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LICDC/LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 885 COMMERCE DR | ||||||||
| Address2: | |||||||||
| City: | PERRYSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435515267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193301050 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1090 W SOUTH BOUNDARY ST STE 600 | ||||||||
| Address2: | |||||||||
| City: | PERRYSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435515249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198738320 | ||||||||
| FaxNumber: | 4193305115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2017 | ||||||||
| LastUpdateDate: | 09/19/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | C.1600414 | OH | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YA0400X | LICDC.161545 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.