Provider Demographics
NPI:1922421452
Name:HURT, BOBBIE-JO (LPC, CSAC, MA, QMHP)
Entity Type:Individual
Prefix:MRS
First Name:BOBBIE-JO
Middle Name:
Last Name:HURT
Suffix:
Gender:F
Credentials:LPC, CSAC, MA, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 LUCK AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-5000
Mailing Address - Country:US
Mailing Address - Phone:540-342-0411
Mailing Address - Fax:540-342-3307
Practice Address - Street 1:541 LUCK AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-5000
Practice Address - Country:US
Practice Address - Phone:540-342-0411
Practice Address - Fax:540-342-3307
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102705101YA0400X
VA0701005748101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)