Provider Demographics
NPI:1972127553
Name:HACKETT, BRIDGET C (LMHC)
Entity type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:C
Last Name:HACKETT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 ROXBORO CT
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-9113
Mailing Address - Country:US
Mailing Address - Phone:386-804-0719
Mailing Address - Fax:
Practice Address - Street 1:2355 ROXBORO CT
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-3272
Practice Address - Country:US
Practice Address - Phone:386-804-0719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-30
Last Update Date:2020-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17970101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health