MEDICARE: REBECCA JO HODGES LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701005635	VA
2	101YP2500X	Professional Counselor	2949-125	WI

General Provider Information

NPI Number	:	1194136309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA JO HODGES LPC

Provider Business Mailing Address
First Line	:	3327 NANSEMOND RIVER DR
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23435-1057
Country	:	US
Telephone Number	:	757-809-0909
Fax Number	:

Provider Business Practice Location Address
First Line	:	3327 NANSEMOND RIVER DR
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23435-1057
Country	:	US
Telephone Number	:	757-809-0909
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2014
Last Update Date	:	05/12/2014

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