Healthcare Provider Details

I. General information

NPI: 1982171112
Provider Name (Legal Business Name): MCLEODD HOBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2018
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 BROOKEDGE DR
COLONIAL HEIGHTS VA
23834-2416
US

IV. Provider business mailing address

307 BROOKEDGE DR
COLONIAL HEIGHTS VA
23834-2416
US

V. Phone/Fax

Practice location:
  • Phone: 804-324-8686
  • Fax:
Mailing address:
  • Phone: 804-324-8686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0711000334
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number0711000334
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: