Provider Demographics
NPI:1447960075
Name:HARTLEY, ADDIE (LCSWA, LCASA)
Entity type:Individual
Prefix:
First Name:ADDIE
Middle Name:
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:LCSWA, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 RUTHIES RD # 1
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-9646
Mailing Address - Country:US
Mailing Address - Phone:828-962-0917
Mailing Address - Fax:
Practice Address - Street 1:174 RUTHIES RD # 1
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-9646
Practice Address - Country:US
Practice Address - Phone:828-962-0917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker