Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | P009216 | NC |
NPI | 1003213851 |
---|---|
Provider Name | Lorenzo T. Hansley |
First Address | Hillsborough, NC 27278-9036 |
Second Address | Greensboro, NC 27403-1120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2014 |
Last Update Date | 16/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C010484 | SWC&LB (01) | NC |