Provider Demographics
NPI:1942971833
Name:HACKNEY, RAVENN SHANNEL (MSW)
Entity Type:Individual
Prefix:MS
First Name:RAVENN
Middle Name:SHANNEL
Last Name:HACKNEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 LAMAR ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3310
Mailing Address - Country:US
Mailing Address - Phone:919-286-1509
Mailing Address - Fax:
Practice Address - Street 1:1913 LAMAR ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3310
Practice Address - Country:US
Practice Address - Phone:919-286-1509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27572101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)