Provider Demographics
NPI:1477580504
Name:HOAG, TERRI LYNN (LICSW)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:LYNN
Last Name:HOAG
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 TODD ACRES DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619-9237
Mailing Address - Country:US
Mailing Address - Phone:727-422-4656
Mailing Address - Fax:888-369-0354
Practice Address - Street 1:5100 TODD ACRES DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36619-9237
Practice Address - Country:US
Practice Address - Phone:727-422-4656
Practice Address - Fax:888-369-0354
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN60191041C0700X
FLSW67071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1150Medicare NSC
FL920323385301Medicare ID - Type UnspecifiedPROVIDER NUMBER