=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548535073
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANA M HACKEY LCSW-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2012
-----------------------------------------------------
Last Update Date | 07/25/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22 E SECOND ST
-----------------------------------------------------
City | FREDERICK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21701-5303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-422-3556
-----------------------------------------------------
Fax | 301-698-9369
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26826 KAYE RD
-----------------------------------------------------
City | LAUREL
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19956-2608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-422-3556
-----------------------------------------------------
Fax | 302-990-5985
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | AC1561
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 14435
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------