MEDICARE: MR. GREGORY D HORNBACK LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0701002919	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457356982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGORY D HORNBACK LPC

Provider Business Mailing Address
First Line	:	PO BOX 332
Second Line	:
City	:	DALEVILLE
State	:	VA
Zip	:	24083-0332
Country	:	US
Telephone Number	:	540-526-4673
Fax Number	:	540-591-9911

Provider Business Practice Location Address
First Line	:	1450 ROANOKE RD
Second Line	:
City	:	DALEVILLE
State	:	VA
Zip	:	24083-2935
Country	:	US
Telephone Number	:	540-526-4673
Fax Number	:	540-591-9914

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	01/24/2011

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