Provider Demographics
NPI:1891284105
Name:HODRICK, VONYA (LSW, LPC)
Entity Type:Individual
Prefix:
First Name:VONYA
Middle Name:
Last Name:HODRICK
Suffix:
Gender:F
Credentials:LSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 CASCADE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-2883
Mailing Address - Country:US
Mailing Address - Phone:470-223-7641
Mailing Address - Fax:
Practice Address - Street 1:2795 MAIN ST W STE 19B
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3072
Practice Address - Country:US
Practice Address - Phone:470-223-7641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0028088104100000X
OHC.1801075101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000000OtherN/A