Provider Demographics
NPI:1982950168
Name:HODGES CLANIN, SALLY E (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:E
Last Name:HODGES CLANIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SALLY
Other - Middle Name:ELIZABETH
Other - Last Name:HODGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:55 JONESBORO ST
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3164
Mailing Address - Country:US
Mailing Address - Phone:828-989-0160
Mailing Address - Fax:
Practice Address - Street 1:55 JONESBORO ST
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3164
Practice Address - Country:US
Practice Address - Phone:828-989-0160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0044761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical