Provider Demographics
NPI:1972514701
Name:HITCHCOCK, AMY R
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:R
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 1:808 GANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35769-4126
Mailing Address - Country:US
Mailing Address - Phone:256-574-4598
Mailing Address - Fax:
Practice Address - Street 1:508 GREGORY ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-4239
Practice Address - Country:US
Practice Address - Phone:256-256-1771
Practice Address - Fax:256-259-0761
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51022246HITOtherBCBS