Provider Demographics
NPI:1679645626
Name:HODGE, LYNN MILLER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:MILLER
Last Name:HODGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6918 SHALLOWFORD RD SUITE 200
Mailing Address - Street 2:TRI STATE PSYCHIATRIC SERVICES
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421
Mailing Address - Country:US
Mailing Address - Phone:423-499-6165
Mailing Address - Fax:423-499-0693
Practice Address - Street 1:6918 SHALLOWFORD RD SUITE 200
Practice Address - Street 2:TRI STATE PSYCHIATRIC SERVICES
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421
Practice Address - Country:US
Practice Address - Phone:423-499-6165
Practice Address - Fax:423-499-0693
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1087104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker