Provider Demographics
NPI:1992272256
Name:HODGE, MINDY LYNNE (BS, LLMSW, CADC)
Entity type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:LYNNE
Last Name:HODGE
Suffix:
Gender:F
Credentials:BS, LLMSW, CADC
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:LYNNE
Other - Last Name:DEBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:204 MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738-2013
Mailing Address - Country:US
Mailing Address - Phone:231-633-0465
Mailing Address - Fax:
Practice Address - Street 1:204 MEADOWS DR
Practice Address - Street 2:
Practice Address - City:GRAYLING
Practice Address - State:MI
Practice Address - Zip Code:49738-2013
Practice Address - Country:US
Practice Address - Phone:231-633-0465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MI6801101698101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker