Provider Demographics
NPI:1245305028
Name:HASTY, PHYLLIS G (MSW)
Entity type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:G
Last Name:HASTY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 902
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-0902
Mailing Address - Country:US
Mailing Address - Phone:304-327-5331
Mailing Address - Fax:304-327-5336
Practice Address - Street 1:1705 JEFFERSON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-4013
Practice Address - Country:US
Practice Address - Phone:304-327-5331
Practice Address - Fax:304-327-5336
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009394881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical