Provider Demographics
NPI:1881024594
Name:HASTING, THERESA RENEE WILSON (LPC-S)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:RENEE WILSON
Last Name:HASTING
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 KEAWE ST STE 204
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2486
Mailing Address - Country:US
Mailing Address - Phone:470-655-6278
Mailing Address - Fax:877-760-0394
Practice Address - Street 1:64 KEAWE ST STE 204
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2486
Practice Address - Country:US
Practice Address - Phone:470-655-6278
Practice Address - Fax:877-760-0394
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-15
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61414101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional