Provider Demographics
NPI:1831308717
Name:HATAWAY, CYNTHIA A (LPC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:HATAWAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 COUNTY ROAD 452
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:AL
Mailing Address - Zip Code:36453-4536
Mailing Address - Country:US
Mailing Address - Phone:334-565-9877
Mailing Address - Fax:
Practice Address - Street 1:301 ANDREWS AVE
Practice Address - Street 2:SUITE T-125
Practice Address - City:FORT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362-5333
Practice Address - Country:US
Practice Address - Phone:334-255-7797
Practice Address - Fax:334-255-7923
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL897101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL62-20338OtherUBH BASIC
AL62-30338OtherUBH PLUS