Provider Demographics
NPI:1922516947
Name:HETTINGER, ALBERTEIN GAYLE (LPC)
Entity Type:Individual
Prefix:
First Name:ALBERTEIN
Middle Name:GAYLE
Last Name:HETTINGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ALI
Other - Middle Name:GAYLE
Other - Last Name:HETTINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:300 GIRAFFE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-6270
Mailing Address - Country:US
Mailing Address - Phone:319-239-5489
Mailing Address - Fax:
Practice Address - Street 1:1729 W BROADWAY STE 8
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-1190
Practice Address - Country:US
Practice Address - Phone:319-239-5489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017044667101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor