Individual
HOLLY I HATHAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1650 COCHRANE CIR # B7500, FORT CARSON, CO 80913-4613
(207) 615-2620
Mailing address
160 COCHRANE CIRCLE B7500, EVANS ARMY COMMUNITY HOSPITAL, FORT CARSON, CO 80913
(207) 615-2620
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LC5406
ME
104100000X
Social Worker
CSW29925611
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
417130099
—
ME
Enumeration date
04/11/2007
Last updated
07/21/2022
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