Provider Demographics
NPI:1992045231
Name:HATFIELD, DAMONDE
Entity Type:Individual
Prefix:
First Name:DAMONDE
Middle Name:
Last Name:HATFIELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2333
Mailing Address - Country:US
Mailing Address - Phone:510-459-0041
Mailing Address - Fax:
Practice Address - Street 1:2627 67TH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2333
Practice Address - Country:US
Practice Address - Phone:510-459-0041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-23
Last Update Date:2013-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health