MEDICARE: DISHONDA HOPKINS LCSW

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	1041C0700X	Clinical Social Worker	SW14205	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SW14205	OTHER	FL	LCSW

General Provider Information

NPI Number	:	1740719632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DISHONDA HOPKINS LCSW

Provider Business Mailing Address
First Line	:	2533 GEORGETOWN LN
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-6818
Country	:	US
Telephone Number	:	850-830-5262
Fax Number	:

Provider Business Practice Location Address
First Line	:	2533 GEORGETOWN LN
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-6818
Country	:	US
Telephone Number	:	850-830-5262
Fax Number	:

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

Provider Enumeration Date	:	06/05/2017
Last Update Date	:	07/21/2022

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