Provider Demographics
NPI:1205492097
Name:HOBSON, GRACE ANTIONETTE (MACC, LCPC)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ANTIONETTE
Last Name:HOBSON
Suffix:
Gender:F
Credentials:MACC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15309 DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419-3127
Mailing Address - Country:US
Mailing Address - Phone:708-769-2683
Mailing Address - Fax:
Practice Address - Street 1:15309 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419-3127
Practice Address - Country:US
Practice Address - Phone:708-769-2683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180013035101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional