Basic Information
| Provider Information | |||||||||
| NPI: | 1629720321 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HATHHORN | ||||||||
| FirstName: | CELESTIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2329 BELLFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441063117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309801523 | ||||||||
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| Practice Location | |||||||||
| Address1: | 215 MILLER RD STE 7 | ||||||||
| Address2: | |||||||||
| City: | AVON LAKE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440121013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4407421661 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2022 | ||||||||
| LastUpdateDate: | 01/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | S.2202302-TRNE | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.