Provider Demographics
NPI:1114508942
Name:HACKETT, RONDELL COLLINS (RSW)
Entity type:Individual
Prefix:
First Name:RONDELL
Middle Name:COLLINS
Last Name:HACKETT
Suffix:
Gender:F
Credentials:RSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 CAREY ST
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-3627
Mailing Address - Country:US
Mailing Address - Phone:985-646-6406
Mailing Address - Fax:985-646-6460
Practice Address - Street 1:2331 CAREY ST
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-3627
Practice Address - Country:US
Practice Address - Phone:985-646-6406
Practice Address - Fax:985-646-6460
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710103446101YA0400X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)