Healthcare Provider Details

I. General information

NPI: 1285186395
Provider Name (Legal Business Name): KYLIE HATHAWAY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 E VICTORY DR STE E
SAVANNAH GA
31404-3730
US

IV. Provider business mailing address

79 WOODBURY LN
POOLER GA
31322-4946
US

V. Phone/Fax

Practice location:
  • Phone: 334-752-2784
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number527
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number7006
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: