Provider Demographics
NPI:1720409055
Name:HODGE, TRINA LYNN (MS)
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:LYNN
Last Name:HODGE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 NW PEACOCK BLVD STE 9
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2213
Mailing Address - Country:US
Mailing Address - Phone:772-344-4020
Mailing Address - Fax:
Practice Address - Street 1:590 NW PEACOCK BLVD STE 9
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2213
Practice Address - Country:US
Practice Address - Phone:772-344-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health