Healthcare Provider Details

I. General information

NPI: 1477580504
Provider Name (Legal Business Name): TERRI LYNN HOAG LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 TODD ACRES DR
MOBILE AL
36619-9237
US

IV. Provider business mailing address

5100 TODD ACRES DR
MOBILE AL
36619-9237
US

V. Phone/Fax

Practice location:
  • Phone: 727-422-4656
  • Fax: 888-369-0354
Mailing address:
  • Phone: 727-422-4656
  • Fax: 888-369-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6019
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number258786
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06314900
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number123249
License Number StateIA
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5031C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: