Provider Demographics
NPI:1699144279
Name:HODGE, TERRA DEMETRIA (LCAS, LCSW-A)
Entity type:Individual
Prefix:
First Name:TERRA
Middle Name:DEMETRIA
Last Name:HODGE
Suffix:
Gender:F
Credentials:LCAS, LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 HARKNESS CIR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-7363
Mailing Address - Country:US
Mailing Address - Phone:919-389-0801
Mailing Address - Fax:
Practice Address - Street 1:305 HARKNESS CIR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-7363
Practice Address - Country:US
Practice Address - Phone:919-389-0801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-20382101YA0400X
NCP0088281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)