Provider Demographics
NPI:1821624362
Name:HITCHCOCK, LAYNE
Entity Type:Individual
Prefix:
First Name:LAYNE
Middle Name:
Last Name:HITCHCOCK
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 1:36 GOBBLERS RUN
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-4242
Mailing Address - Country:US
Mailing Address - Phone:304-904-9360
Mailing Address - Fax:
Practice Address - Street 1:36 GOBBLERS RUN
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-4242
Practice Address - Country:US
Practice Address - Phone:304-904-9360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2267101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional