Individual
DR. CHARLES DUDLEIGH HACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
316 TEA BERRY LN., BIG CANOE, GA 30143-3014
(404) 375-0914
Mailing address
10298 BIG CANOE, BIG CANOE, GA 30143-5121
(404) 731-2578
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MFT000579
GA
Other
Enumeration date
07/09/2018
Last updated
07/09/2018
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