Provider Demographics
NPI:1437321114
Name:HODGES, SHANNON L (LPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:HODGES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3664 DESHA RD
Mailing Address - Street 2:
Mailing Address - City:TAPPAHANNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22560-5422
Mailing Address - Country:US
Mailing Address - Phone:804-445-5175
Mailing Address - Fax:
Practice Address - Street 1:414 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:VA
Practice Address - Zip Code:22572
Practice Address - Country:US
Practice Address - Phone:804-333-3671
Practice Address - Fax:804-333-3657
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004172101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1497717615OtherVA PREMIER
VA1497717615Medicaid