Provider Demographics
NPI:1780418509
Name:HATHAWAY, KATHLEEN DENISE (EDD, LMFT)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:DENISE
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:EDD, LMFT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:DENISE
Other - Last Name:CHEATHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4935 SKYLARK ST NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98516-4524
Mailing Address - Country:US
Mailing Address - Phone:253-230-5237
Mailing Address - Fax:
Practice Address - Street 1:4935 SKYLARK ST NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98516-4524
Practice Address - Country:US
Practice Address - Phone:253-230-5237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMFT.LF.00001292106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist