Provider Demographics
NPI:1992005425
Name:HATCHETT, PRUDENCE LAQUITA (MS)
Entity type:Individual
Prefix:MS
First Name:PRUDENCE
Middle Name:LAQUITA
Last Name:HATCHETT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5137 FAIN LN
Mailing Address - Street 2:
Mailing Address - City:BELDEN
Mailing Address - State:MS
Mailing Address - Zip Code:38826-9751
Mailing Address - Country:US
Mailing Address - Phone:662-871-4569
Mailing Address - Fax:
Practice Address - Street 1:5137 FAIN LN
Practice Address - Street 2:
Practice Address - City:BELDEN
Practice Address - State:MS
Practice Address - Zip Code:38826-9751
Practice Address - Country:US
Practice Address - Phone:662-871-4569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
101YM0800X, 101YP2500X
MS101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health