Provider Demographics
NPI:1689926768
Name:HATMAKER, DAVID A (MA, DMIN)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:HATMAKER
Suffix:
Gender:M
Credentials:MA, DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 CHERRY HILLS PL
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-8220
Mailing Address - Country:US
Mailing Address - Phone:321-400-5438
Mailing Address - Fax:
Practice Address - Street 1:16607 RIVERSTONE WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-5749
Practice Address - Country:US
Practice Address - Phone:321-400-5438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4484101YM0800X
NC10642101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional