Provider Demographics
NPI:1093798126
Name:DAVIES-HACKENBERG, RHIANNON (LCSW)
Entity Type:Individual
Prefix:
First Name:RHIANNON
Middle Name:
Last Name:DAVIES-HACKENBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 N WITCHDUCK RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6544
Mailing Address - Country:US
Mailing Address - Phone:757-497-3670
Mailing Address - Fax:757-499-1947
Practice Address - Street 1:256 N WITCHDUCK RD
Practice Address - Street 2:SUITE G
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6544
Practice Address - Country:US
Practice Address - Phone:757-497-3670
Practice Address - Fax:757-499-1947
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040024381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010082854Medicaid
VA005715T11Medicare ID - Type Unspecified