Provider Demographics
NPI:1568872430
Name:HATHCOCK, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:HATHCOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12743 BLUE HOLLY DR APT 14
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4565
Mailing Address - Country:US
Mailing Address - Phone:765-610-3439
Mailing Address - Fax:
Practice Address - Street 1:12743 BLUE HOLLY DR APT 14
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-4565
Practice Address - Country:US
Practice Address - Phone:765-610-3439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst