Provider Demographics
NPI:1215754247
Name:HANNELORE, PERLA
Entity type:Individual
Prefix:
First Name:PERLA
Middle Name:
Last Name:HANNELORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 WINDSOR AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-5014
Mailing Address - Country:US
Mailing Address - Phone:212-444-2488
Mailing Address - Fax:
Practice Address - Street 1:730 WINDSOR AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-5014
Practice Address - Country:US
Practice Address - Phone:212-444-2488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME103K00000X
VA0133004112103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty