Healthcare Provider Details

I. General information

NPI: 1164812251
Provider Name (Legal Business Name): CARISSA ANNE HOBBS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2015
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 THUNDERSTICK DR. SUITE 1104
LEXINGTON KY
40505
US

IV. Provider business mailing address

2250 THUNDERSTICK DR. SUITE 1104
LEXINGTON KY
40505-9010
US

V. Phone/Fax

Practice location:
  • Phone: 859-254-1035
  • Fax: 859-254-2075
Mailing address:
  • Phone: 859-254-1035
  • Fax: 859-254-2075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number252899
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: