Provider Demographics
NPI:1083383996
Name:HODGES, SHANNNON DIONDREA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANNNON
Middle Name:DIONDREA
Last Name:HODGES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 LAUREL LOCH LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-1899
Mailing Address - Country:US
Mailing Address - Phone:318-220-6191
Mailing Address - Fax:
Practice Address - Street 1:2312 LAUREL LOCH LN
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-1899
Practice Address - Country:US
Practice Address - Phone:318-220-6191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX548271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical