Provider Demographics
NPI:1457678435
Name:HODGES, SERENA (LADC)
Entity Type:Individual
Prefix:MRS
First Name:SERENA
Middle Name:
Last Name:HODGES
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 NW HOMESTEAD DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5243
Mailing Address - Country:US
Mailing Address - Phone:580-355-8883
Mailing Address - Fax:580-355-8885
Practice Address - Street 1:1320 NW HOMESTEAD DR
Practice Address - Street 2:SUITE G
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5243
Practice Address - Country:US
Practice Address - Phone:580-355-8883
Practice Address - Fax:580-355-8885
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK#667101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional