Provider Demographics
NPI:1497487789
Name:HODGE, KINIKIA SHARI (LCSW)
Entity Type:Individual
Prefix:DR
First Name:KINIKIA
Middle Name:SHARI
Last Name:HODGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:DR
Other - First Name:KINIKIA
Other - Middle Name:SHARI
Other - Last Name:BURDINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6927 SARRIA
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-5549
Mailing Address - Country:US
Mailing Address - Phone:214-289-7002
Mailing Address - Fax:
Practice Address - Street 1:2 MANHATTANVILLE RD
Practice Address - Street 2:
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-2113
Practice Address - Country:US
Practice Address - Phone:817-819-8322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX639201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical