Provider Demographics
NPI:1932855947
Name:HODGE, JOSEPH (LCPC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:HODGE
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BROADWAY ST STE 110
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-6696
Mailing Address - Country:US
Mailing Address - Phone:240-801-7799
Mailing Address - Fax:
Practice Address - Street 1:201 BROADWAY ST STE 110
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6696
Practice Address - Country:US
Practice Address - Phone:240-801-7799
Practice Address - Fax:240-801-7799
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2024-05-17
Deactivation Date:2022-05-22
Deactivation Code:
Reactivation Date:2023-03-01
Provider Licenses
StateLicense IDTaxonomies
MDLC13562101YM0800X
MDLGP11433101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional