Provider Demographics
NPI:1346351806
Name:HATTEM, DAVID MICHAEL (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:HATTEM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 PROFESSOR PLACE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713
Mailing Address - Country:US
Mailing Address - Phone:919-572-0271
Mailing Address - Fax:
Practice Address - Street 1:820 S BOYLAN AVE
Practice Address - Street 2:DOROTHEA DIX HOSPITAL
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27699-3601
Practice Address - Country:US
Practice Address - Phone:919-733-9935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1204103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical