Provider Demographics
NPI:1073237665
Name:HODGES, TINA (LMSW)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:HODGES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NORTHPOINTE PKWY APT 113
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-2395
Mailing Address - Country:US
Mailing Address - Phone:601-559-9266
Mailing Address - Fax:
Practice Address - Street 1:145 RAYMOND RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3802
Practice Address - Country:US
Practice Address - Phone:601-362-5321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM10219104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker