Provider Demographics
NPI:1366633281
Name:CARROLL-RATLIFF, HATTIE (LPC)
Entity Type:Individual
Prefix:
First Name:HATTIE
Middle Name:
Last Name:CARROLL-RATLIFF
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 S VALLEY RD STE 207
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1473
Mailing Address - Country:US
Mailing Address - Phone:484-886-4214
Mailing Address - Fax:
Practice Address - Street 1:30 S VALLEY RD STE 207
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301
Practice Address - Country:US
Practice Address - Phone:484-886-4214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00360300101YP2500X
PAPC005410101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional