Provider Demographics
NPI:1477260099
Name:HATCHER, LAVERNE IDA (LCSW-A)
Entity Type:Individual
Prefix:
First Name:LAVERNE
Middle Name:IDA
Last Name:HATCHER
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 WINBURN DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8366
Mailing Address - Country:US
Mailing Address - Phone:336-577-5702
Mailing Address - Fax:
Practice Address - Street 1:177 SIMS PKWY
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7627
Practice Address - Country:US
Practice Address - Phone:980-859-3331
Practice Address - Fax:888-730-1933
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP017541101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health