Provider Demographics
NPI:1801625264
Name:HATHCOCK COUNSELING, LLC
Entity type:Organization
Organization Name:HATHCOCK COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARED
Authorized Official - Middle Name:M
Authorized Official - Last Name:DIXON HATHCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:904-314-3380
Mailing Address - Street 1:1820 STATE ROAD NORTH
Mailing Address - Street 2:SUITE 11-79
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259
Mailing Address - Country:US
Mailing Address - Phone:904-314-3380
Mailing Address - Fax:904-314-3380
Practice Address - Street 1:178 WORTHINGTON PKWY
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-6916
Practice Address - Country:US
Practice Address - Phone:904-314-3380
Practice Address - Fax:904-314-3380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty