Basic Information
Provider Information
NPI: 1255643250
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HASTIE
FirstName: CASHENA
MiddleName: LATEEFAH
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
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Mailing Information
Address1: 3555 HARDEN STREET EXT
Address2: 15 MEDICAL PARK, SUITE 300
City: COLUMBIA
State: SC
PostalCode: 292036894
CountryCode: US
TelephoneNumber: 8034346412
FaxNumber: 8034341537
Practice Location
Address1: 15 MEDICAL PARK, STE 141
Address2: GENERAL PSYCHIATRY
City: COLUMBIA
State: SC
PostalCode: 29203
CountryCode: US
TelephoneNumber: 8034341433
FaxNumber: 8034344351
Other Information
ProviderEnumerationDate: 07/07/2010
LastUpdateDate: 01/20/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800XLL32715SCY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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