Provider Demographics
NPI:1598036204
Name:HODGE, MAEGAN NICHOLE (LAC)
Entity Type:Individual
Prefix:MS
First Name:MAEGAN
Middle Name:NICHOLE
Last Name:HODGE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N 20TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-6976
Mailing Address - Country:US
Mailing Address - Phone:804-234-3843
Mailing Address - Fax:804-482-5206
Practice Address - Street 1:20 N 20TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-6976
Practice Address - Country:US
Practice Address - Phone:804-234-3843
Practice Address - Fax:804-482-5206
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000639171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist