Provider Demographics
NPI:1750081188
Name:HODGE, NTASHA (LPC)
Entity type:Individual
Prefix:
First Name:NTASHA
Middle Name:
Last Name:HODGE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HARBOR POINTE DR
Mailing Address - Street 2:
Mailing Address - City:STONE MTN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-6191
Mailing Address - Country:US
Mailing Address - Phone:470-767-0796
Mailing Address - Fax:
Practice Address - Street 1:5405 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3234
Practice Address - Country:US
Practice Address - Phone:678-999-2611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013419101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health