Provider Demographics
NPI:1780776948
Name:HODGES, LAURA R (LPC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:R
Last Name:HODGES
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 1:2703 NIX LN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-6988
Mailing Address - Country:US
Mailing Address - Phone:434-713-0300
Mailing Address - Fax:
Practice Address - Street 1:1717 EXECUTIVE SQ
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6091
Practice Address - Country:US
Practice Address - Phone:870-935-4102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003934101YP2500X
ARP1508087101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional