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General NPI Number Information
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NPI Number | 1619694957
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Entity Type | Individual
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Provider Name | CHANTELLE HODGE MA, MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 10/27/2022
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 2041 MARTIN LUTHER KING JR AVE SE
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City | WASHINGTON
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State | DC
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Zip | 20020-7024
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Country | US
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Telephone | 202-547-8450
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Fax |
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Provider Business Mailing Address
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Address Line | 2041 MARTIN LUTHER KING JR AVE SE STE M8205239
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City | WASHINGTON
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State | DC
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Zip | 20020-7024
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Country | US
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Telephone | 202-547-8450
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC15774
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PRC200002265
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License Number State | DC
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