Provider Demographics
NPI:1669137147
Name:HACKING, REBECCA LEE (LAC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEE
Last Name:HACKING
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 SOOY PLACE RD
Mailing Address - Street 2:
Mailing Address - City:VINCENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-6904
Mailing Address - Country:US
Mailing Address - Phone:856-986-2457
Mailing Address - Fax:
Practice Address - Street 1:60 CATHY LANE
Practice Address - Street 2:SUITE 103
Practice Address - City:FLORENCE
Practice Address - State:NJ
Practice Address - Zip Code:08088
Practice Address - Country:US
Practice Address - Phone:609-499-0165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00606100101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor