Provider Demographics
NPI:1053884510
Name:HACKBARTH, JAMES MICHAEL (LPCA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:HACKBARTH
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 ROOK ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-3014
Mailing Address - Country:US
Mailing Address - Phone:252-767-3830
Mailing Address - Fax:
Practice Address - Street 1:841 ROOK ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-3014
Practice Address - Country:US
Practice Address - Phone:252-767-3830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1437425113Medicaid