Provider Demographics
NPI:1639429707
Name:HATHAWAY, ANGIE DELYNN RYAN
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:DELYNN RYAN
Last Name:HATHAWAY
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 1:2186 NC 55 E
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-7004
Mailing Address - Country:US
Mailing Address - Phone:828-434-5380
Mailing Address - Fax:
Practice Address - Street 1:2186 NC 55 E
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-7004
Practice Address - Country:US
Practice Address - Phone:828-434-5380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor