Provider Demographics
NPI:1366258527
Name:HATHAWAY, CAMERON GRACE (MS, LPA)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:GRACE
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:MS, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6590 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-8210
Mailing Address - Country:US
Mailing Address - Phone:409-781-8651
Mailing Address - Fax:
Practice Address - Street 1:6590 WOODRIDGE DR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-8210
Practice Address - Country:US
Practice Address - Phone:409-781-8651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40485103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist