Provider Demographics
NPI:1568123578
Name:HATTEN, PEGGIE LEE (BA, MD, SAC,)
Entity Type:Individual
Prefix:
First Name:PEGGIE
Middle Name:LEE
Last Name:HATTEN
Suffix:
Gender:F
Credentials:BA, MD, SAC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6021 PORTSMOUTH CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-7103
Mailing Address - Country:US
Mailing Address - Phone:334-647-1880
Mailing Address - Fax:
Practice Address - Street 1:853 S COURT ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36104-4905
Practice Address - Country:US
Practice Address - Phone:334-647-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)