Provider Demographics
NPI:1477362705
Name:HODGE, REBECCA (MS, LPCC)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:HODGE
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8317 PARKGLEN DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-4098
Mailing Address - Country:US
Mailing Address - Phone:719-429-9474
Mailing Address - Fax:
Practice Address - Street 1:8317 PARKGLEN DR
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-4098
Practice Address - Country:US
Practice Address - Phone:719-429-9474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0022859101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health