Provider Demographics
NPI:1366722639
Name:HODGES, HEATHER MONIQUE (CSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MONIQUE
Last Name:HODGES
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 TUNNEL HILL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-8067
Mailing Address - Country:US
Mailing Address - Phone:270-765-2335
Mailing Address - Fax:270-765-2557
Practice Address - Street 1:1106 TUNNEL HILL RD
Practice Address - Street 2:STE 100
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8067
Practice Address - Country:US
Practice Address - Phone:270-765-2335
Practice Address - Fax:270-765-2557
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY62611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical