Provider Demographics
NPI:1114368669
Name:HACKER, PATTI A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATTI
Middle Name:A
Last Name:HACKER
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 1:208 PRESSON RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:VA
Mailing Address - Zip Code:23696-2610
Mailing Address - Country:US
Mailing Address - Phone:757-898-0668
Mailing Address - Fax:757-898-0668
Practice Address - Street 1:208 PRESSON RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:VA
Practice Address - Zip Code:23696-2610
Practice Address - Country:US
Practice Address - Phone:757-898-0668
Practice Address - Fax:757-898-0668
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040046651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical