Provider Demographics
NPI:1295965895
Name:HASTIE, SUZANNE CAROL (MA,BC-DMT,NCC,LPC)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:CAROL
Last Name:HASTIE
Suffix:
Gender:F
Credentials:MA,BC-DMT,NCC,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4144
Mailing Address - Country:US
Mailing Address - Phone:484-221-8586
Mailing Address - Fax:484-221-8586
Practice Address - Street 1:628 TWIN PONDS RD
Practice Address - Street 2:
Practice Address - City:BREINIGSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18031-1843
Practice Address - Country:US
Practice Address - Phone:610-417-0831
Practice Address - Fax:484-221-8586
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002827101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional