Provider Demographics
NPI:1700894169
Name:HODGES, SAMUEL EDDIE (LPC)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:EDDIE
Last Name:HODGES
Suffix:
Gender:M
Credentials:LPC
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 1364
Mailing Address - Street 2:
Mailing Address - City:COLLINS
Mailing Address - State:MS
Mailing Address - Zip Code:39428-1364
Mailing Address - Country:US
Mailing Address - Phone:601-765-4514
Mailing Address - Fax:601-584-4053
Practice Address - Street 1:22 WESTVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:COLLINS
Practice Address - State:MS
Practice Address - Zip Code:39428
Practice Address - Country:US
Practice Address - Phone:601-765-4514
Practice Address - Fax:601-584-4053
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0167101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor