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General NPI Number Information
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NPI Number | 1235738741
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Entity Type | Individual
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Provider Name | TINA HACKER LICDC
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Gender | Female
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 1750 GRANVILLE PIKE
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City | LANCASTER
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State | OH
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Zip | 43130-1041
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Country | US
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Telephone | 833-510-4357
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Fax | 866-460-2997
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Provider Business Mailing Address
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Address Line | 31 HIDEAWAY DR
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City | COVINGTON
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State | KY
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Zip | 41017-9775
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Country | US
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Telephone | 859-307-4540
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 262182
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 283958
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LICDC.162615
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License Number State | OH
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