Doctor Name: | AMY LYNN HANCOCK |
NPI Number: | 1144523960 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | BA,CADC, GCE |
License Number: | 25397 |
Business Practice Address: | 3248 Vandever Ave Pekin, IL - 615546257 |
Business Phone Number: | 3093475579 |
Business Fax Number: | 3093474264 |
Mailing Address: | 3248 Vandever Ave, PEKIN |
State: | IL |
Postal Code: | 615546257 |
Phone Number: | 3093475579 |
Fax Number: | 3093474264 |
NPI Enumeration Date: | 12/16/2010 |
NPI Last Update Date: | 12/16/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 25397 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |