Provider Demographics
NPI:1316786544
Name:HACKNEY, DOMONIQUE A
Entity type:Individual
Prefix:
First Name:DOMONIQUE
Middle Name:A
Last Name:HACKNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12022 167TH DR NE APT 3
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-5861
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 721426
Practice Address - Street 2:
Practice Address - City:NAALEHU
Practice Address - State:HI
Practice Address - Zip Code:96772-1119
Practice Address - Country:US
Practice Address - Phone:808-977-0134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMHCA.MC.61465055101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health