Individual
CHARLOTTE A HAZELTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, CADC
Contact information
Practice address
3175 CUSTER DR STE 200, LEXINGTON, KY 40517-4023
(859) 273-1288
(859) 273-1278
Mailing address
3430 BROOKHAVEN DR, LEXINGTON, KY 40502-3331
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
0400
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100544800
—
KY
Enumeration date
10/05/2006
Last updated
02/25/2022
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