Provider Demographics
NPI:1356135461
Name:HODGES, KIZZY RENEE (LCSWA, LCASA)
Entity type:Individual
Prefix:
First Name:KIZZY
Middle Name:RENEE
Last Name:HODGES
Suffix:
Gender:
Credentials:LCSWA, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 342
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-0342
Mailing Address - Country:US
Mailing Address - Phone:252-402-4801
Mailing Address - Fax:
Practice Address - Street 1:131 N MARKET ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4947
Practice Address - Country:US
Practice Address - Phone:252-402-4801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-05
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30451101YA0400X
NCP0213721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)