Healthcare Provider Details

I. General information

NPI: 1205230604
Provider Name (Legal Business Name): DAVID HOOVER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2014
Last Update Date: 02/08/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PACIFIC GUARDIAN BH BLDG 1073
APO AP
96273-0047
US

IV. Provider business mailing address

42035 LOUDOUN CENTER PL
LEESBURG VA
20175-8954
US

V. Phone/Fax

Practice location:
  • Phone: 315-737-5842
  • Fax:
Mailing address:
  • Phone: 571-258-0320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904012651
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: