Provider Demographics
NPI:1548936131
Name:HASTINGS, GWENDY EVA (CO 61079088)
Entity type:Individual
Prefix:MRS
First Name:GWENDY
Middle Name:EVA
Last Name:HASTINGS
Suffix:
Gender:F
Credentials:CO 61079088
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1865 WATKINS RD
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:WA
Mailing Address - Zip Code:98249-9482
Mailing Address - Country:US
Mailing Address - Phone:360-610-7726
Mailing Address - Fax:
Practice Address - Street 1:31640 STATE ROUTE 20 STE 1
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3128
Practice Address - Country:US
Practice Address - Phone:360-679-7676
Practice Address - Fax:360-682-5947
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61079088101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)