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General NPI Number Information
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NPI Number | 1497487789
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Entity Type | Individual
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Provider Name | KINIKIA SHARI HODGE LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/27/2022
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 2 MANHATTANVILLE RD
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City | PURCHASE
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State | NY
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Zip | 10577-2113
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Country | US
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Telephone | 817-819-8322
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Fax |
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Provider Business Mailing Address
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Address Line | 6927 SARRIA
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City | GRAND PRAIRIE
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State | TX
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Zip | 75054-5549
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Country | US
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Telephone | 214-289-7002
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 63920
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License Number State | TX
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