Basic Information
| Provider Information | |||||||||
| NPI: | 1811527237 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HATFIELD | ||||||||
| FirstName: | CLINT | ||||||||
| MiddleName: | |||||||||
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| Credential: | CDCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 303 GERVAIS RD | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN FURNACE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456298742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402597000 | ||||||||
| FaxNumber: | 7402597003 | ||||||||
| Practice Location | |||||||||
| Address1: | 303 GERVAIS RD | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN FURNACE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456298742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402597000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2020 | ||||||||
| LastUpdateDate: | 01/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | 172564 | OH | N | Other Service Providers | Case Manager/Care Coordinator | 101YA0400X | 172564 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.