Provider Demographics
NPI:1720285281
Name:THACKER, BARBARA G (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:G
Last Name:THACKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 KAPIOLANI BLVD
Mailing Address - Street 2:F-3
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814
Mailing Address - Country:US
Mailing Address - Phone:808-973-8387
Mailing Address - Fax:808-973-5295
Practice Address - Street 1:1680 KAPIOLANI BLVD
Practice Address - Street 2:F-3
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3713
Practice Address - Country:US
Practice Address - Phone:808-973-8387
Practice Address - Fax:808-973-5295
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1223103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist