Healthcare Provider Details

I. General information

NPI: 1871184259
Provider Name (Legal Business Name): GYPSEY ROSE HOBBS CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 S PAINT ST
CHILLICOTHEE OH
45601-3202
US

IV. Provider business mailing address

18 S PAINT ST
CHILLICOTHEE OH
45601-3202
US

V. Phone/Fax

Practice location:
  • Phone: 740-888-1377
  • Fax:
Mailing address:
  • Phone: 740-888-1377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number176170
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: