Provider Demographics
NPI:1093804106
Name:HATCHETT, AUDRA RENAE (LCSW)
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:RENAE
Last Name:HATCHETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AUDRA
Other - Middle Name:
Other - Last Name:PRINCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 S ARKANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-6732
Mailing Address - Country:US
Mailing Address - Phone:479-567-5800
Mailing Address - Fax:479-567-5801
Practice Address - Street 1:1001 S ARKANSAS AVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-6732
Practice Address - Country:US
Practice Address - Phone:479-567-5800
Practice Address - Fax:479-567-5801
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2060-C104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker