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Individual
REVAE L HACKETT
Active
Individual
REVAE L HACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
R4238
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
OR
101YP2500X
Professional Counselor
C4820
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500678512
—
OR
Enumeration date
10/28/2014
Last updated
06/21/2021
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