Provider Demographics
NPI:1679033351
Name:HASTIE, JEAN M (LPCA, NCC)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:HASTIE
Suffix:
Gender:F
Credentials:LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2913 SCUPPERNONG LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-9264
Mailing Address - Country:US
Mailing Address - Phone:919-598-0600
Mailing Address - Fax:
Practice Address - Street 1:2913 SCUPPERNONG LN
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-9264
Practice Address - Country:US
Practice Address - Phone:919-598-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14410101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor