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Individual

REVA RENEE HACKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPCC

Contact information

Practice address
86 HIGHWAY 638 STE 1, MANCHESTER, KY 40962-7289
(606) 598-0070
(844) 273-1765
Mailing address
86 HIGHWAY 638 STE 1, MANCHESTER, KY 40962-7289
(606) 598-0070

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
167212
KY
101YM0800X
Mental Health Counselor

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7100409560
KY
Enumeration date
06/23/2010
Last updated
01/30/2020
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