Provider Demographics
NPI:1720204175
Name:HODGE, SHERRY D (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:D
Last Name:HODGE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-4050
Mailing Address - Country:US
Mailing Address - Phone:810-733-2675
Mailing Address - Fax:
Practice Address - Street 1:1125 S LINDEN RD
Practice Address - Street 2:SUITE 950
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4073
Practice Address - Country:US
Practice Address - Phone:810-780-4163
Practice Address - Fax:810-780-4321
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801080190101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health