MEDICARE: TERRA HODGE

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1760222939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERRA HODGE

Provider Business Mailing Address
First Line	:	305 HARKNESS CIR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-7363
Country	:	US
Telephone Number	:	919-389-0801
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 HARKNESS CIR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-7363
Country	:	US
Telephone Number	:	919-389-0801
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	TERRA D HODGE
Credential	:
Telephone Number	:	919-389-0801

Provider Enumeration Date	:	05/27/2024
Last Update Date	:	05/27/2024

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