Provider Demographics
NPI:1619499159
Name:THERESA HOCKENSMITH, PLLC
Entity Type:Organization
Organization Name:THERESA HOCKENSMITH, PLLC
Other - Org Name:THERESA HOCKENSMITH, LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOCKENSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:859-361-0460
Mailing Address - Street 1:134 HALL ST
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-1332
Mailing Address - Country:US
Mailing Address - Phone:859-361-0460
Mailing Address - Fax:859-276-5206
Practice Address - Street 1:200 W LOWRY LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3019
Practice Address - Country:US
Practice Address - Phone:859-278-1814
Practice Address - Fax:859-276-5206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-15
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2524531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty