Provider Demographics
NPI:1093891467
Name:HODGES, CHARLES E JR (LCSW, CSOTP)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:HODGES
Suffix:JR
Gender:M
Credentials:LCSW, CSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5407 S JESSUP RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-8244
Mailing Address - Country:US
Mailing Address - Phone:804-868-0070
Mailing Address - Fax:
Practice Address - Street 1:5407 S JESSUP RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-8244
Practice Address - Country:US
Practice Address - Phone:804-868-0070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904003862101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health