Provider Demographics
NPI:1568051282
Name:HODELIN, MICHELE A (LCSW, ACSW)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:A
Last Name:HODELIN
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5709 KENSINGTON PL
Mailing Address - Street 2:
Mailing Address - City:BONSALL
Mailing Address - State:CA
Mailing Address - Zip Code:92003-3801
Mailing Address - Country:US
Mailing Address - Phone:727-776-8286
Mailing Address - Fax:
Practice Address - Street 1:5709 KENSINGTON PL
Practice Address - Street 2:
Practice Address - City:BONSALL
Practice Address - State:CA
Practice Address - Zip Code:92003-3801
Practice Address - Country:US
Practice Address - Phone:727-776-8286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-17
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW907741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical