Provider Demographics
NPI:1134366214
Name:HACKNEY, KEELY MICHELE (MS, BCBA)
Entity type:Individual
Prefix:MRS
First Name:KEELY
Middle Name:MICHELE
Last Name:HACKNEY
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:MISS
Other - First Name:KEELY
Other - Middle Name:MICHELE
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:545 OLD NORCROSS RD STE 200A
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3390
Mailing Address - Country:US
Mailing Address - Phone:770-596-3828
Mailing Address - Fax:
Practice Address - Street 1:545 OLD NORCROSS RD STE 200A
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3390
Practice Address - Country:US
Practice Address - Phone:770-596-3828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst