Provider Demographics
NPI:1972801967
Name:HODGES, JEAN MARY (LLMSW)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:MARY
Last Name:HODGES
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37130 MCKINLEY CT
Mailing Address - Street 2:APT. 653
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-1859
Mailing Address - Country:US
Mailing Address - Phone:248-957-8547
Mailing Address - Fax:
Practice Address - Street 1:16647 WYOMING ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2848
Practice Address - Country:US
Practice Address - Phone:313-342-3606
Practice Address - Fax:313-861-0413
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801092829101YA0400X
MI101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)