Provider Information for 1952465551
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SANDRA HACK MS, LPC, LMHC
Sex: Female
NPI: 1952465551
Last Updated: 2016-06-27
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1952465551 | ||||||||||||
| Enumeration Date | 2006-12-20 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | PO BOX 374 VENICE, FL 34284-0374 United States Phone: | Fax: | ||||||||||||
| Primary Practice Address | 224 PONCE DE LEON AVE VENICE, FL 34285-2330 United States Phone: 941-882-0566 | Fax: | ||||||||||||
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