Provider Demographics
NPI:1184996175
Name:HODGE, MAURITA MARICE (EDD, LPC)
Entity type:Individual
Prefix:DR
First Name:MAURITA
Middle Name:MARICE
Last Name:HODGE
Suffix:
Gender:F
Credentials:EDD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4637 RAVENWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-6037
Mailing Address - Country:US
Mailing Address - Phone:770-306-6127
Mailing Address - Fax:
Practice Address - Street 1:4637 RAVENWOOD LOOP
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-6037
Practice Address - Country:US
Practice Address - Phone:770-306-6127
Practice Address - Fax:770-995-1959
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006683101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional