Provider Demographics
NPI:1508476995
Name:HOBACK, MELISSA ANN (CDCA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:HOBACK
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 GREEN ACRES DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KY
Mailing Address - Zip Code:41169-1067
Mailing Address - Country:US
Mailing Address - Phone:606-371-2011
Mailing Address - Fax:
Practice Address - Street 1:12266 STATE ROUTE 5
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-8099
Practice Address - Country:US
Practice Address - Phone:606-928-2881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000374189101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)