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Individual

JERIESHA HODGE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1412 CRAIN HWY N STE 5B, GLEN BURNIE, MD 21061-9306
(202) 531-0231
Mailing address
1412 CRAIN HWY N STE 5B, GLEN BURNIE, MD 21061-9306
(202) 531-0231
(888) 907-0899

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
LC6401
MD
101YA0400X
Addiction (Substance Use Disorder) Counselor
LC6401
MD
101YM0800X
Mental Health Counselor
Primary
LC6401
MD
101YP2500X
Professional Counselor
LC6401
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
660402100
MD
05
745048600
MD
Enumeration date
01/06/2016
Last updated
02/12/2019
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