Provider Demographics
NPI:1932339694
Name:HACKETT-HAYES, HEATHER (BCBA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:HACKETT-HAYES
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 GUIBOR CT NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-3816
Mailing Address - Country:US
Mailing Address - Phone:610-780-0364
Mailing Address - Fax:678-324-1792
Practice Address - Street 1:368 GUIBOR CT NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-3816
Practice Address - Country:US
Practice Address - Phone:610-780-0364
Practice Address - Fax:678-324-1792
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-09-4891103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst