Healthcare Provider Details

I. General information

NPI: 1679926950
Provider Name (Legal Business Name): CINDY HATFIELD FRUITS PSY. D, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CINDY LEA HATFIELD PSY. D, LPC

II. Dates (important events)

Enumeration Date: 07/21/2016
Last Update Date: 07/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4839 N. MAIN STREET
ACWORTH GA
30101
US

IV. Provider business mailing address

4839 N. MAIN STREET
ACWORTH GA
30101
US

V. Phone/Fax

Practice location:
  • Phone: 770-547-2070
  • Fax: 770-485-9228
Mailing address:
  • Phone: 770-547-2070
  • Fax: 770-485-9228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLPC008884
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: