Provider Demographics
NPI:1306412564
Name:HODGES, ANDREA LINDSAY (LLMSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LINDSAY
Last Name:HODGES
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23606 LONGACRE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48335-3322
Mailing Address - Country:US
Mailing Address - Phone:619-876-1207
Mailing Address - Fax:
Practice Address - Street 1:29991 MITCHELL ST BLDG 328
Practice Address - Street 2:
Practice Address - City:SELFRIDGE ANGB
Practice Address - State:MI
Practice Address - Zip Code:48045-4957
Practice Address - Country:US
Practice Address - Phone:734-677-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011096701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical