Provider Demographics
NPI:1922183185
Name:HODGES, MICHELLE FAYE (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:FAYE
Last Name:HODGES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MIRRAMONT LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-8215
Mailing Address - Country:US
Mailing Address - Phone:770-517-3363
Mailing Address - Fax:770-517-3308
Practice Address - Street 1:131 MIRRAMONT LAKE DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-8215
Practice Address - Country:US
Practice Address - Phone:770-517-3363
Practice Address - Fax:770-517-3308
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA26721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical