Individual
CHARLETT HODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
260 4TH ST, FAYETTEVILLE, GA 30214-4618
(202) 210-2530
Mailing address
260 4TH ST, FAYETTEVILLE, GA 30214-4618
(202) 210-2530
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC011781
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
APC006089
4
GA
Enumeration date
07/10/2018
Last updated
10/16/2024
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