Healthcare Provider Details

I. General information

NPI: 1972089043
Provider Name (Legal Business Name): VICTORIA ANN HODGES MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 E KINGSTON SPRINGS RD
KINGSTON SPRINGS TN
37082-9090
US

IV. Provider business mailing address

170 E KINGSTON SPRINGS RD
KINGSTON SPRINGS TN
37082-9090
US

V. Phone/Fax

Practice location:
  • Phone: 615-952-2811
  • Fax:
Mailing address:
  • Phone: 615-952-2811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: