Healthcare Provider Details

I. General information

NPI: 1629983671
Provider Name (Legal Business Name): JUSTIN LATODD HACKETT ALC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 3RD AVE N
BESSEMER AL
35020-5775
US

IV. Provider business mailing address

5285 BRIDLE PATH LN
PINSON AL
35126-6432
US

V. Phone/Fax

Practice location:
  • Phone: 205-795-3410
  • Fax:
Mailing address:
  • Phone: 205-541-0047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberALC06140
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: