Healthcare Provider Details

I. General information

NPI: 1346847209
Provider Name (Legal Business Name): MACIE HOBBS MSW, LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 KETTERING BLVD
MORAINE OH
45439-1989
US

IV. Provider business mailing address

3055 KETTERING BLVD
MORAINE OH
45439-1989
US

V. Phone/Fax

Practice location:
  • Phone: 614-459-4490
  • Fax:
Mailing address:
  • Phone: 614-459-4490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2304635
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: