Provider Demographics
NPI:1417667452
Name:HODGES, JESSICA DAWN (LPC, CSAC, NCC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:DAWN
Last Name:HODGES
Suffix:
Gender:F
Credentials:LPC, CSAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-3275
Mailing Address - Country:US
Mailing Address - Phone:276-821-8030
Mailing Address - Fax:423-900-2435
Practice Address - Street 1:261 NORTH ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3275
Practice Address - Country:US
Practice Address - Phone:276-821-8030
Practice Address - Fax:423-900-2435
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710103734101YA0400X
VA0701011819101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)