Individual
MR. MARK ANDREW HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPCC 15352
Contact information
Practice address
1470 BLUEGRASS LN, TRACY, CA 95377-9245
(925) 209-8546
Mailing address
1470 BLUEGRASS LN, TRACY, CA 95377-9245
(925) 209-8546
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
H1012021917
CA
101YP2500X
Professional Counselor
Primary
15352
CA
Other
Enumeration date
10/10/2013
Last updated
12/27/2023
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