MEDICARE: MS. DANA ANN HIATT LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	4579	NC

General Provider Information

NPI Number	:	1053517318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANA ANN HIATT LPC

Provider Business Mailing Address
First Line	:	2000 W 1ST ST
Second Line	:	SUITE 510
City	:	WINSTON SALEM
State	:	NC
Zip	:	27104-4225
Country	:	US
Telephone Number	:	336-748-0809
Fax Number	:	336-748-0809

Provider Business Practice Location Address
First Line	:	2000 W 1ST ST
Second Line	:	SUITE 510
City	:	WINSTON SALEM
State	:	NC
Zip	:	27104-4225
Country	:	US
Telephone Number	:	336-748-0809
Fax Number	:	336-748-0809

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	07/08/2007

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