Basic Information
| Provider Information | |||||||||
| NPI: | 1083907281 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAZATONES | ||||||||
| FirstName: | DEMETRA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | LADC, LCMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX G | ||||||||
| Address2: | |||||||||
| City: | RANDOLPH | ||||||||
| State: | VT | ||||||||
| PostalCode: | 050600167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027284466 | ||||||||
| FaxNumber: | 8027284197 | ||||||||
| Practice Location | |||||||||
| Address1: | 1483 LOWER PLAIN | ||||||||
| Address2: | |||||||||
| City: | BRADFORD | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022224477 | ||||||||
| FaxNumber: | 8022223242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2011 | ||||||||
| LastUpdateDate: | 10/29/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 068.0122237 | VT | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YA0400X | 000538 | VT | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.