Provider Demographics
NPI:1982977567
Name:HODGE-JEFFERSON, ADINA ELIZABETH (MH 12675)
Entity Type:Individual
Prefix:
First Name:ADINA
Middle Name:ELIZABETH
Last Name:HODGE-JEFFERSON
Suffix:
Gender:F
Credentials:MH 12675
Other - Prefix:
Other - First Name:ADINA
Other - Middle Name:ELIZABETH
Other - Last Name:SAMUEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1389 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-5431
Mailing Address - Country:US
Mailing Address - Phone:561-818-8454
Mailing Address - Fax:
Practice Address - Street 1:1389 MEADOWBROOK DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-5431
Practice Address - Country:US
Practice Address - Phone:561-818-8454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16275101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health