Provider Demographics
NPI:1134470776
Name:HATHORNE, LILLIAN PATRICIA
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:PATRICIA
Last Name:HATHORNE
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 1:31145 WELLINGTON DR
Mailing Address - Street 2:APARTMENT 22303
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-4168
Mailing Address - Country:US
Mailing Address - Phone:734-306-6382
Mailing Address - Fax:313-396-5353
Practice Address - Street 1:2925 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4825
Practice Address - Country:US
Practice Address - Phone:313-396-5300
Practice Address - Fax:313-396-5353
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-22
Last Update Date:2012-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator