Individual
MISS ODESSA MAVIS THOMAS HANCOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
13395 N MARANA MAIN ST BLDG B, MARANA, AZ 85653-7008
(520) 682-1091
Mailing address
13395 N MARANA MAIN ST BLDG B, MARANA, AZ 85653-7008
(520) 682-1091
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCAS-15573
NC
104100000X
Social Worker
LMSW-19637
AZ
104100000X
Social Worker
P005543
NC
104100000X
Social Worker
P015881
NC
1041C0700X
Clinical Social Worker
Primary
LCSW-22353
AZ
1041S0200X
School Social Worker
1217085
NC
Other
Enumeration date
09/22/2011
Last updated
06/26/2024
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