Healthcare Provider Details

I. General information

NPI: 1902056567
Provider Name (Legal Business Name): EILEEN R HODGES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 LEESBURG DR
LELAND NC
28451-9386
US

IV. Provider business mailing address

1044 LEESBURG DR
LELAND NC
28451-9386
US

V. Phone/Fax

Practice location:
  • Phone: 201-294-8545
  • Fax: 201-358-1386
Mailing address:
  • Phone: 201-294-8545
  • Fax: 201-358-1386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05362700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC010143
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: