Provider Demographics
NPI:1104023811
Name:HOBACK, NANETTE M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NANETTE
Middle Name:M
Last Name:HOBACK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13808 MIKEN CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-3743
Mailing Address - Country:US
Mailing Address - Phone:703-791-6092
Mailing Address - Fax:703-791-9974
Practice Address - Street 1:7502 DIPLOMAT DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2631
Practice Address - Country:US
Practice Address - Phone:703-401-5875
Practice Address - Fax:703-791-9974
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040025861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1104023811Medicaid