Provider Demographics
NPI:1184825523
Name:HATHCOAT, STEPHANIE DAWN (CADC US)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:DAWN
Last Name:HATHCOAT
Suffix:
Gender:F
Credentials:CADC US
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:PARK HILL
Mailing Address - State:OK
Mailing Address - Zip Code:74451-0002
Mailing Address - Country:US
Mailing Address - Phone:918-775-2657
Mailing Address - Fax:918-775-0439
Practice Address - Street 1:1515 W CHICKASAW AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-7201
Practice Address - Country:US
Practice Address - Phone:918-775-2657
Practice Address - Fax:918-775-0439
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor