Provider Demographics
NPI:1700131919
Name:HOAG, GINA (LCSW-C MS)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:HOAG
Suffix:
Gender:F
Credentials:LCSW-C MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 FAIRWOOD VIEW CT
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:MD
Mailing Address - Zip Code:21131-1301
Mailing Address - Country:US
Mailing Address - Phone:410-917-2421
Mailing Address - Fax:
Practice Address - Street 1:15 FAIRWOOD VIEW CT
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:MD
Practice Address - Zip Code:21131-1301
Practice Address - Country:US
Practice Address - Phone:410-917-2421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD072791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical