Provider Demographics
NPI:1326073529
Name:HACK, BRADLEY JACOB (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:JACOB
Last Name:HACK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6512 SIX FORKS RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6561
Mailing Address - Country:US
Mailing Address - Phone:919-518-0390
Mailing Address - Fax:919-341-8210
Practice Address - Street 1:6512 SIX FORKS RD
Practice Address - Street 2:SUITE 302
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6561
Practice Address - Country:US
Practice Address - Phone:919-518-0390
Practice Address - Fax:919-341-8210
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2434103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical