Provider Demographics
NPI:1649701392
Name:HAVILAND, CATHERINE (MS CTRS)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:
Last Name:HAVILAND
Suffix:
Gender:F
Credentials:MS CTRS
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 1372
Mailing Address - Street 2:
Mailing Address - City:NORRIS
Mailing Address - State:TN
Mailing Address - Zip Code:37828-1372
Mailing Address - Country:US
Mailing Address - Phone:865-382-3307
Mailing Address - Fax:
Practice Address - Street 1:212 OAK ROAD
Practice Address - Street 2:
Practice Address - City:NORRIS
Practice Address - State:TN
Practice Address - Zip Code:37828-1372
Practice Address - Country:US
Practice Address - Phone:865-382-3307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNNCTRC40240101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor