Provider Demographics
NPI:1255923850
Name:HATHAWAY, VALERIE (LLP)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 W LAKE LANSING RD STE 400
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8528
Mailing Address - Country:US
Mailing Address - Phone:517-337-6545
Mailing Address - Fax:517-337-3010
Practice Address - Street 1:612 W LAKE LANSING RD STE 400
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8528
Practice Address - Country:US
Practice Address - Phone:517-337-6545
Practice Address - Fax:517-337-3010
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361007896103T00000X
MI6362009270103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty