Provider Demographics
NPI:1750631271
Name:HODGE, RACHEL L (MS)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:L
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 1:3360 BEVIA RD
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-6920
Mailing Address - Country:US
Mailing Address - Phone:850-212-1517
Mailing Address - Fax:
Practice Address - Street 1:3360 BEVIA RD
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-6920
Practice Address - Country:US
Practice Address - Phone:850-212-1517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health