Healthcare Provider Details

I. General information

NPI: 1225776123
Provider Name (Legal Business Name): VICKIE MARIE HOBBS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2022
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 FAIRMONT CT
CLOVIS NM
88101-5056
US

IV. Provider business mailing address

1500 FAIRMONT CT
CLOVIS NM
88101-5056
US

V. Phone/Fax

Practice location:
  • Phone: 575-714-1742
  • Fax:
Mailing address:
  • Phone: 575-714-1742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-10778
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: