Basic Information
| Provider Information | |||||||||
| NPI: | 1124770011 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOPPER | ||||||||
| FirstName: | ALAITHEA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMHCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7530 S COUNTY ROAD 450 W | ||||||||
| Address2: | |||||||||
| City: | STILESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461809714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602016470 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 308 MEDIC WAY | ||||||||
| Address2: | |||||||||
| City: | GREENCASTLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461352296 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8887141927 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2022 | ||||||||
| LastUpdateDate: | 01/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.