Provider Demographics
NPI:1730704990
Name:HOCKENBERRY, EMILY ADELE
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ADELE
Last Name:HOCKENBERRY
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 1:819 S HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-5157
Mailing Address - Country:US
Mailing Address - Phone:949-900-5380
Mailing Address - Fax:714-861-6430
Practice Address - Street 1:819 S HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5157
Practice Address - Country:US
Practice Address - Phone:949-900-5380
Practice Address - Fax:714-861-6430
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-13
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty