Provider Demographics
NPI:1245847359
Name:HASTINGS, SHARIECE INEZ (MS,CRC,LCPC)
Entity type:Individual
Prefix:
First Name:SHARIECE
Middle Name:INEZ
Last Name:HASTINGS
Suffix:
Gender:F
Credentials:MS,CRC,LCPC
Other - Prefix:
Other - First Name:SHARIECE
Other - Middle Name:INEZ
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,CRC,LCPC
Mailing Address - Street 1:904 E CINDY ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-3318
Mailing Address - Country:US
Mailing Address - Phone:618-203-1574
Mailing Address - Fax:
Practice Address - Street 1:904 E CINDY ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-3318
Practice Address - Country:US
Practice Address - Phone:618-203-1574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.012216101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional