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General NPI Number Information
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NPI Number | 1891284105
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Entity Type | Individual
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Provider Name | VONYA HODRICK LSW, LPC
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Gender | Female
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Dates
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Enumeration Date | 05/02/2018
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Last Update Date | 05/02/2018
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Provider Practice Location Address
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Address Line | 2795 MAIN ST W STE 19B
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City | SNELLVILLE
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State | GA
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Zip | 30078-3072
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Country | US
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Telephone | 470-223-7641
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Fax |
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Provider Business Mailing Address
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Address Line | 1337 CASCADE VIEW DR
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City | GRAYSON
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State | GA
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Zip | 30017-2883
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Country | US
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Telephone | 470-223-7641
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.0028088
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License Number State | OH
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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 | C.1801075
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License Number State | OH
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