Individual
MRS. STEPHANIE ANNE HATHORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5422 CLINTON BLVD, JACKSON, MS 39209-3004
(601) 724-5040
Mailing address
200 PARK CIRCLE DR STE 1, FLOWOOD, MS 39232-7800
(601) 664-0455
(601) 664-1675
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
1947
MS
106H00000X
Marriage & Family Therapist
T0465
MS
106H00000X
Marriage & Family Therapist
Primary
T0465A
MS
Other
Enumeration date
06/04/2013
Last updated
03/24/2021
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