Provider Demographics
NPI:1689608135
Name:HOSACK, DAYLE DOREEN (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:DAYLE
Middle Name:DOREEN
Last Name:HOSACK
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 CLAIRMONT RD
Mailing Address - Street 2:#204
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1259
Mailing Address - Country:US
Mailing Address - Phone:404-818-6535
Mailing Address - Fax:040-321-9667
Practice Address - Street 1:1244 CLAIRMONT ROAD
Practice Address - Street 2:#204
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1259
Practice Address - Country:US
Practice Address - Phone:404-818-6535
Practice Address - Fax:404-321-9667
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA832106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist