Provider Demographics
NPI:1346443504
Name:HATCHER, CARMELETA DIANNE (LCSW, CADC-III)
Entity Type:Individual
Prefix:MS
First Name:CARMELETA
Middle Name:DIANNE
Last Name:HATCHER
Suffix:
Gender:F
Credentials:LCSW, CADC-III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 SE WESTVIEW
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97264
Mailing Address - Country:US
Mailing Address - Phone:503-260-2955
Mailing Address - Fax:
Practice Address - Street 1:5125 SW MACADAM AVE
Practice Address - Street 2:145
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3820
Practice Address - Country:US
Practice Address - Phone:503-231-7854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR060773101YA0400X
ORL34441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical