Provider Demographics
NPI:1619340445
Name:KYEISHA HODGE, LLC
Entity Type:Organization
Organization Name:KYEISHA HODGE, LLC
Other - Org Name:INTROSPECTIVE COUNSELING SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KYEISHA
Authorized Official - Middle Name:EBONY
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHCA
Authorized Official - Phone:205-774-0502
Mailing Address - Street 1:1903 NE 85TH ST
Mailing Address - Street 2:APT 405
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-8203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1903 NE 85TH ST
Practice Address - Street 2:APT 405
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-8203
Practice Address - Country:US
Practice Address - Phone:205-775-0502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60507339101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty