Provider Demographics
NPI:1821645383
Name:HACKETT, MICHELLE MARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:HACKETT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 BUSINESS CENTER DR.
Mailing Address - Street 2:STE. 108 # 193
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534
Mailing Address - Country:US
Mailing Address - Phone:707-366-0120
Mailing Address - Fax:
Practice Address - Street 1:1745 ENTERPRISE DR.
Practice Address - Street 2:BLDG. 2, STE 1A
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533
Practice Address - Country:US
Practice Address - Phone:707-927-4282
Practice Address - Fax:707-247-4233
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111565106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist