Provider Demographics
NPI:1265962484
Name:HOBBIE, GORDON DALE (PHD)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:DALE
Last Name:HOBBIE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44402 CROSS COUNTRY BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:FL
Mailing Address - Zip Code:32702-9238
Mailing Address - Country:US
Mailing Address - Phone:407-756-0677
Mailing Address - Fax:
Practice Address - Street 1:1964 HOWELL BRANCH RD STE 106
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-1042
Practice Address - Country:US
Practice Address - Phone:407-756-0677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2710101YM0800X
FLLMHC2710101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health