Provider Demographics
NPI:1629720321
Name:HATHHORN, CELESTIA
Entity Type:Individual
Prefix:
First Name:CELESTIA
Middle Name:
Last Name:HATHHORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2329 BELLFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-3117
Mailing Address - Country:US
Mailing Address - Phone:330-980-1523
Mailing Address - Fax:
Practice Address - Street 1:215 MILLER RD STE 7
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-1013
Practice Address - Country:US
Practice Address - Phone:440-742-1661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2202302-TRNE1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical