MEDICARE: CHARLOTTE HACKLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1780378828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE HACKLEY

Provider Business Mailing Address
First Line	:	650 PENNSYLVANIA AVE SE STE 330
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20003-4397
Country	:	US
Telephone Number	:	202-864-4186
Fax Number	:	202-864-4158

Provider Business Practice Location Address
First Line	:	965 FLORIDA AVE NW APT 359
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20001-5573
Country	:	US
Telephone Number	:	202-705-2949
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2023
Last Update Date	:	08/01/2023

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Directions to “ CHARLOTTE HACKLEY ” Practice Location

Language	Start Address	Practice Location

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