Provider Demographics
NPI:1376648527
Name:HACKNEY, CAROL COVINGTON (LCPC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:COVINGTON
Last Name:HACKNEY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5916
Mailing Address - Country:US
Mailing Address - Phone:208-336-3900
Mailing Address - Fax:208-342-6553
Practice Address - Street 1:500 W BANNOCK ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5916
Practice Address - Country:US
Practice Address - Phone:208-336-3900
Practice Address - Fax:208-342-6553
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-341101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDQ2093OtherBLUE CROSS