Provider Demographics
NPI:1760620553
Name:HAKESLEY, FAITH ANN
Entity Type:Individual
Prefix:MRS
First Name:FAITH
Middle Name:ANN
Last Name:HAKESLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:FAITH
Other - Middle Name:ANN
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 UNION ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-3922
Mailing Address - Country:US
Mailing Address - Phone:978-620-1778
Mailing Address - Fax:978-683-5986
Practice Address - Street 1:115 UNION ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-3922
Practice Address - Country:US
Practice Address - Phone:978-620-1778
Practice Address - Fax:978-683-5986
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA042777145Medicaid