Provider Demographics
NPI:1184912107
Name:HATHCOCK, DENISE
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:HATHCOCK
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 1:1735 ENTERPRISE DR
Mailing Address - Street 2:SUITE 105A
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6822
Mailing Address - Country:US
Mailing Address - Phone:707-425-1799
Mailing Address - Fax:
Practice Address - Street 1:125 NORMANDY DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-5943
Practice Address - Country:US
Practice Address - Phone:707-452-0855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor