Provider Demographics
NPI:1306314877
Name:HOOVER, EMMALINA MARY CONSUL
Entity type:Individual
Prefix:
First Name:EMMALINA
Middle Name:MARY CONSUL
Last Name:HOOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMMALINA
Other - Middle Name:MARY CONSUL
Other - Last Name:MOZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2331 HANSEN CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-4859
Mailing Address - Country:US
Mailing Address - Phone:850-320-6555
Mailing Address - Fax:
Practice Address - Street 1:2331 HANSEN CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-4859
Practice Address - Country:US
Practice Address - Phone:850-320-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101281200Medicaid