Provider Demographics
NPI:1144554999
Name:HARTWICK, SEDONIA AIME (CADAC)
Entity type:Individual
Prefix:MS
First Name:SEDONIA
Middle Name:AIME
Last Name:HARTWICK
Suffix:
Gender:F
Credentials:CADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 BERGQUIST AVE STE 101
Mailing Address - Street 2:59 MHS
Mailing Address - City:LACKLAND AFB
Mailing Address - State:TX
Mailing Address - Zip Code:78236-9907
Mailing Address - Country:US
Mailing Address - Phone:210-292-6022
Mailing Address - Fax:210-292-7712
Practice Address - Street 1:2200 BERGQUIST AVE STE 101
Practice Address - Street 2:59 MHS
Practice Address - City:LACKLAND AFB
Practice Address - State:TX
Practice Address - Zip Code:78236-9907
Practice Address - Country:US
Practice Address - Phone:210-292-6022
Practice Address - Fax:210-292-7712
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111395101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)