Provider Demographics
NPI:1598278673
Name:HOOD, KERSONDRA CORRINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KERSONDRA
Middle Name:CORRINE
Last Name:HOOD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CLOEIE
Other - Middle Name:
Other - Last Name:HOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:8950 W EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4854
Mailing Address - Country:US
Mailing Address - Phone:208-376-7083
Mailing Address - Fax:
Practice Address - Street 1:8950 W EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4854
Practice Address - Country:US
Practice Address - Phone:208-376-7083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-10
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-36585104100000X
IDLCSW-391691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker