Provider Demographics
NPI:1821404443
Name:HOCKENSMITH, THERESA
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:HOCKENSMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2524531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical