MEDICARE: MCLEODD HOBBS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	0711000334	VA
2	175T00000X	Peer Specialist	0711000334	VA

General Provider Information

NPI Number	:	1982171112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCLEODD HOBBS

Provider Business Mailing Address
First Line	:	307 BROOKEDGE DR
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2416
Country	:	US
Telephone Number	:	804-324-8686
Fax Number	:

Provider Business Practice Location Address
First Line	:	307 BROOKEDGE DR
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2416
Country	:	US
Telephone Number	:	804-324-8686
Fax Number	:

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

Provider Enumeration Date	:	10/25/2018
Last Update Date	:	10/25/2018

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