Provider Demographics
NPI:1174350995
Name:HACKWORTH, SAVANNA F (MA, LPCA)
Entity type:Individual
Prefix:
First Name:SAVANNA
Middle Name:F
Last Name:HACKWORTH
Suffix:
Gender:F
Credentials:MA, LPCA
Other - Prefix:
Other - First Name:SAVANNA
Other - Middle Name:F
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPCA
Mailing Address - Street 1:PO BOX 802
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-0802
Mailing Address - Country:US
Mailing Address - Phone:859-428-7862
Mailing Address - Fax:859-999-7869
Practice Address - Street 1:229 CHURCHILL DR STE 2
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3218
Practice Address - Country:US
Practice Address - Phone:859-428-7862
Practice Address - Fax:859-999-7869
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY292445101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional